CPT 00844: Anesthesia for Abdominoperineal Resection
CPT code 00844 designates anesthesia services for abdominoperineal resection, a complex colorectal operation that removes low rectal tumors and the anus. Nationally, this code represents high-acuity intra-abdominal and perineal anesthesia care associated with lengthy operating times, advanced airway and hemodynamic management, and multidisciplinary perioperative coordination. It is relevant to hospitals, anesthesiology groups, and payers for service classification, coverage determination, and claims processing.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for 00844, comparisons to related lower- and higher-complexity anesthesia codes, and typical billing considerations tied to operative complexity and site of service. The publication outlines benchmark themes, coding relationships to neighboring CPT anesthesia codes for lower abdominal and pelvic procedures, and practical information for billing teams and revenue cycle staff.
This summary provides the clinical framing and payer scope needed to interpret benchmarking data, policy updates, and coding guidance related to anesthesia for extensive abdominoperineal procedures across the national payer landscape.
Sign up for cpt 00844 policy alerts
Get alerted when payer policies referencing 00844 are released or updated.
Billing Code Overview
CPT code 00844 describes anesthesia services provided for a patient undergoing an abdominoperineal resection, a major colorectal operation in which the surgical team removes large, very low rectal tumors along with the anus. This service typically involves comprehensive anesthesia management for a complex open pelvic and perineal procedure.
-
Service type: Major intra-abdominal and perineal surgical anesthesia
-
Typical site of service: Inpatient operating room (open abdominal/perineal surgery)
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with a low rectal adenocarcinoma involving the anal sphincter is scheduled for an abdominoperineal resection. Preoperative evaluation by the anesthesia team (physician anesthesiologist or Certified Registered Nurse Anesthetist) includes review of cardiopulmonary status, medication reconciliation, and assessment for difficult airway. The patient arrives to the operating room after regional bowel preparation and prophylactic antibiotics. General endotracheal anesthesia with invasive arterial monitoring is planned because the procedure is extensive, may involve significant blood loss, and requires both abdominal and perineal phases with patient repositioning. The anesthesia workflow includes induction, endotracheal intubation, central or arterial line placement as indicated, continuous hemodynamic monitoring during the abdominal dissection and pelvic dissection, management of fluid and transfusion needs, multimodal analgesia planning, and handoff to post-anesthesia care unit (PACU) or intensive care unit (ICU) postoperatively. Documentation includes start and stop times for anesthesia, intraoperative events (hemodynamic instability, transfusions, conversions), airway management details, regional blocks if placed, and any applicable modifier indications (for example, unusual procedural difficulty or concurrent procedures).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the anesthesia service required significantly greater work or intensity than usual for 00844 (document rationale). |
23 | Unusual anesthesia | Use when general anesthesia is medically necessary for a procedure usually done with local/regional anesthesia. |
50 | Bilateral procedure | Rare for 00844; use if bilateral separate procedures are performed during same anesthesia encounter and documentation supports. |
52 | Reduced services | Use when the planned anesthesia service for 00844 is partially reduced or not fully performed. |
53 | Discontinued procedure | Use when anesthesia was administered but the surgery was terminated for clinical reasons prior to completion. |
55 | Postoperative management only | Use when the billing practitioner provided only postoperative anesthesia care, not intraoperative services. |
62 | Two surgeons | Use when two surgeons are required and documented for portions of the abdominoperineal resection. |
78 | Unplanned return to OR | Use when the patient returns to the operating room for a related procedure during the global period and additional anesthesia is required. |
AA | Anesthesia service performed by anesthesiologist | Use to indicate the service was personally performed by a physician anesthesiologist. |
AD | Medical supervision by a physician; more than four concurrent anesthesia procedures | Use when a physician supervises multiple concurrent anesthesia providers per CMS rules. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist service | Use when a physician assistant or advanced practice clinician provided the anesthesia service under supervision per applicable rules. |
QK | Medical direction of two, three, or four concurrent anesthesia procedures | Use when the physician medically directed multiple concurrent CRNAs for 00844. |
QX | CRNA service furnished under a physician's supervision | Use when a CRNA provided the service with physician supervision, appended when required for billing. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Anesthesiology | Physician anesthesiologist who directs or personally performs anesthesia for 00844. |
207LA0401X | Anesthesiology Assistant | Anesthesiology assistant participating under physician supervision for intraoperative management. |
367500000X | Certified Registered Nurse Anesthetist | CRNA providing anesthesia care, may be billed with appropriate modifiers and supervision indicators. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
H25.9 | Unspecified age-related cataract | Cataract diagnoses are unrelated to 00844 surgery; included in the provided list but not typically driving anesthesia for abdominoperineal resection. |
H26.9 | Unspecified cataract | See H25.9; ophthalmologic diagnosis present in the medical history that may affect perioperative visual status or consent processes. |
H52.4 | Presbyopia | Common age-related visual condition in the surgical population; not causative for 00844 but documented in comorbidity list. |
H53.8 | Other visual disturbances | Represents visual symptoms in the medical record; may affect communication or postoperative instructions but not surgical indication. |
H54.8 | Legal blindness, as defined in USA | Major comorbidity affecting perioperative planning, patient assistance needs, and informed consent processes; not an indication for 00844. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
00840 | Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; not otherwise specified | Alternative code for lower intraperitoneal abdominal procedures when the specific operation differs from abdominoperineal resection. |
00842 | Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; amniocentesis | Related lower abdominal intraperitoneal anesthesia code for a different specific procedure; used when amniocentesis is the operative event. |
00846 | Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; radical hysterectomy | Related higher-complexity pelvic procedure code; useful for coding when the surgical operation is a radical hysterectomy rather than abdominoperineal resection. |
00848 | Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; pelvic exenteration | Related to extensive pelvic surgery with complexity similar to or greater than 00844; used when pelvic exenteration is performed. |
00851 | Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; tubal ligation/transection | Related lower abdominal intraperitoneal anesthesia code for sterilization procedures; relevant when less extensive pelvic surgery is performed. |