CPT 00846: Anesthesia for Radical Hysterectomy - OpenPayer

Summary & Overview

CPT 00846: Anesthesia for Radical Hysterectomy

CPT code 00846 denotes anesthesia services for a radical hysterectomy, a major gynecologic procedure involving removal of the uterus and surrounding structures. This code captures the anesthesiologist’s or anesthesia team’s perioperative management for complex intraperitoneal pelvic surgery and is used in billing and reimbursement across hospital and ambulatory surgical settings. Nationally, accurate use of this code affects payment integrity, clinical reporting for high-acuity procedures, and aggregate utilization metrics for anesthesia services.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the procedure, commonly associated sites of service, and comparisons to related anesthesia codes for intraperitoneal and pelvic operations. The publication highlights typical billing patterns, common modifiers encountered on claims, and how 00846 relates to adjacent anesthesia codes used for lower abdominal and pelvic procedures.

This summary equips billing managers, anesthesia providers, and revenue cycle stakeholders with a concise reference to the clinical scenario represented by 00846, the payer landscape addressed, and the topics covered in the full publication, including coding relationships, payer considerations, and encounter-level context.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 00846anesthesiaradical hysterectomygynecologic surgeryoperating roomanesthesiology codingsurgical anesthesiaperioperative carebilling and coding

Billing Code Overview

CPT code 00846 describes anesthesia services provided for a patient undergoing a radical hysterectomy, a surgical procedure in which the surgeon removes the uterus along with surrounding structures. The entry denotes the anesthetic management associated with this major gynecologic oncologic operation.

Service Type: Anesthesia for major gynecologic surgery

Typical Site of Service: Operating room (inpatient or outpatient surgical facility)

Clinical & Coding Specifications

Clinical Context

A 52-year-old female presents with abnormal uterine bleeding and a pelvic mass suspicious for malignancy. Preoperative imaging and biopsy suggest invasive cervical or uterine cancer requiring radical hysterectomy with removal of the uterus, parametria, and upper vagina. The patient has a history of hypertension and controlled type 2 diabetes. She is evaluated preoperatively by the anesthesia team (physician anesthesiologist or certified registered nurse anesthetist) with ASA physical status P3 due to systemic disease. On the day of surgery, the patient undergoes standard perioperative preparation: IV access, multimodal monitoring, and informed anesthesia consent. General endotracheal anesthesia is induced for an open radical hysterectomy with possible pelvic lymph node dissection and anticipated moderate-to-large blood loss; invasive arterial monitoring is placed. Anesthesia management includes induction agents, endotracheal intubation, maintenance with volatile anesthetic or total intravenous anesthesia, hemodynamic support, and postoperative pain planning (epidural or multimodal IV analgesia). The anesthesia service is reported with code 00846 for intraperitoneal lower abdominal major surgery (radical hysterectomy). Postoperative handoff includes blood loss, fluid balance, hemodynamics, and recommendations for ICU or PACU monitoring as indicated by intraoperative course (for example, significant hemorrhage or intra-abdominal contamination from peritonitis).

Coding Specifications

Modifiers selected reflect common intraoperative contingencies, personnel, and special circumstances for anesthesia services during a radical hysterectomy.

Modifier	Description

CPT 00830: Anesthesia for Lower Abdominal Hernia Repair, Unspecified

00848

CPT 00848: Anesthesia for Pelvic Exenteration in Lower Abdomen

00834

CPT 00834: Anesthesia for Pediatric Lower Abdominal Hernia Repair

cpt-00880-anesthesia-major-lower-abdominal-vessels

CPT 00880: Anesthesia for Major Lower Abdominal Vascular Procedures

00797

CPT 00797: Anesthesia for Upper Abdominal Intraperitoneal Procedures

cpt-00756-transabdominal-diaphragmatic-hernia-repair-anesthesia

CPT 00756: Anesthesia for Transabdominal Diaphragmatic Hernia Repair

cpt-00866-anesthesia-for-adrenalectomy

CPT 00866: Anesthesia for Adrenal Gland Removal

00810

CPT 00810: Anesthesia for Lower Intestinal Endoscopic Procedures

00752

CPT 00752: Anesthesia for Upper Abdominal Hernia Repairs

cpt-00848-anesthesia-intraperitoneal-lower-abdomen-laparoscopy

CPT 00848: Anesthesia for Intraperitoneal Lower Abdominal Procedures

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`22`	Increased procedural services	Use when anesthesia care required substantially greater work or complexity than typical for `00846` (e.g., prolonged difficult induction, extensive resuscitation).
`23`	Unusual anesthesia	Use when general anesthesia is administered for procedures that are normally performed with local/monitored anesthesia care but in this context required general (less common for this CPT but applicable if indicated).
`25`	Significant, separately identifiable E/M service	Use when a significant preoperative or immediate postoperative evaluation by the anesthesia professional is separately reportable on the day of surgery.
`50`	Bilateral procedure	Use when bilateral surgical procedures are performed in the same operative session and billing policies permit modifier `50` for associated surgical codes (rarely applied to anesthesia codes but included per input).
`52`	Reduced services	Use when the planned anesthesia service is partially reduced or curtailed (e.g., procedure aborted early).
`53`	Discontinued procedure	Use when anesthesia is provided but the surgical procedure is terminated before completion for extenuating circumstances.
`78`	Unplanned return to the operating room after anesthesia during the postoperative period	Use when the patient returns to the OR for a related procedure during the global period requiring additional anesthesia services.
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	Use for portions of anesthesia preoperative evaluation or consults delivered via synchronous telemedicine when payer accepts modifier `95` for such services.
`AA`	Anesthesia services performed personally by anesthesiologist	Use when the anesthesiologist personally performs the anesthesia service.
`AD`	Medical supervision by a physician: more than four concurrent anesthesia procedures	Use when a physician medically supervises multiple simultaneous anesthesia procedures per payer rules.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for anesthesiology	Use when an advanced practice clinician assists in anesthesia as allowed by payer rules.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures involving qualified personnel	Use when the anesthesiologist medically directs multiple concurrent CRNAs or anesthesiology assistants under the allowed model.
`QX`	CRNA service with medical direction by a physician	Use when a certified registered nurse anesthetist performs the anesthesia under physician direction.
`QS`	Monitored anesthesia care service	Use when monitored anesthesia care is provided instead of general anesthesia, when clinically appropriate and billable.

Taxonomy Code	Specialty	Notes
`207L00000X`	Anesthesiology	Physician anesthesiologists perform preoperative assessment, induction, maintenance, and management of complex intraoperative events.
`367500000X`	Certified Registered Nurse Anesthetist	CRNAs provide anesthesia services including for major gynecologic procedures, often under supervision or direction models.
`207RA0401X`	Anesthesiology Assistant	Anesthesiology assistants function under anesthesiologist supervision and participate in intraoperative management for major cases.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K56.60`	Unspecified intestinal obstruction	Bowel obstruction may be a preoperative diagnosis or intraoperative finding during radical hysterectomy, influencing anesthesia management and potential for prolonged surgery.
`K65.9`	Peritonitis, unspecified	Peritonitis indicates intra-abdominal infection or contamination that increases anesthetic risk, may require broader resuscitation and postoperative critical care.
`N83.20`	Unspecified ovarian cyst	Ovarian pathology may be encountered or removed during pelvic oncologic surgery; may alter surgical plan and anesthesia duration.
`K66.1`	Hemoperitoneum	Intra-abdominal bleeding increases risk for significant blood loss and transfusion; requires invasive monitoring and hemodynamic support from anesthesia.
`K63.5`	Polyp of colon	Colonic pathology encountered on exploration can extend procedure scope; relevance for operative time and anesthetic complexity.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`00840`	Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; not otherwise specified	Applicable to other lower intraperitoneal abdominal procedures; may be used when the surgical procedure differs from radical hysterectomy but involves lower intraperitoneal work.
`00844`	Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; abdominoperineal resection	Related major lower abdominal/pelvic procedure; similar anesthetic considerations and potential alternative code for different oncologic resections.
`00848`	Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; pelvic exenteration	Represents a more extensive pelvic resection; related when surgical extent is greater than radical hysterectomy and anesthesia complexity increases.
`00851`	Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; tubal ligation/transection	Represents a less extensive pelvic procedure; included for workflow comparison when scope of surgery is limited compared with radical hysterectomy.

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