CPT 00872: Anesthesia for Extracorporeal Shock Wave Lithotripsy (Partial Submersion) - OpenPayer

Summary & Overview

CPT 00872: Anesthesia for Extracorporeal Shock Wave Lithotripsy (Partial Submersion)

CPT code 00872 captures anesthesia services provided when a patient is partially submerged in liquid during extracorporeal shock wave treatment for kidney or ureteral stones. This specialized anesthesia code is relevant nationally because it identifies cases with unique positioning and environmental considerations that can affect perioperative care, resource use, and billing specificity. Key payers included in analyses are Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise overview of the clinical context for lithotripsy-related anesthesia, common payer coverage considerations, and linked anesthesia complexity codes. The publication summarizes service setting expectations (hospital operating room or ambulatory surgical center) and explains how this code relates to extracorporeal shock wave lithotripsy procedures. It also outlines typical companion anesthesia codes used for complex or age-related cases and emergency events. The material is intended to inform revenue cycle, clinical operations, and coding teams about the purpose of the code, common diagnostic scenarios that trigger its use, and where to locate related procedural codes for the underlying lithotripsy service. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnited HealthcareMedicareCPT 00872anesthesialithotripsyextracorporeal shock waveoperative careambulatory surgeryhospital services

Billing Code Overview

CPT code 00872 describes anesthesia services provided while a patient is partially submerged in liquid during extracorporeal shock wave treatment for a kidney or ureteral stone. This represents anesthesia care specifically associated with lithotripsy procedures where the patient position and partial submersion in liquid are integral to the treatment.

Service type: Anesthesia for extracorporeal shock wave lithotripsy
Typical site of service: Hospital operating room or ambulatory surgical center where extracorporeal shock wave lithotripsy is performed

Clinical & Coding Specifications

Clinical Context

A 48-year-old male presents to the urology clinic with acute right flank pain and hematuria. Imaging (non-contrast CT) confirms a 9-mm obstructing proximal ureteral stone and multiple small renal calculi. The urology team schedules extracorporeal shock wave lithotripsy (ESWL) under monitored anesthesia care. During the procedure the patient is positioned supine and partially submerged in a water-filled coupling bath to allow transmission of shock waves to the renal/ureteral stones. An anesthesia provider (anesthesiologist or certified registered nurse anesthetist) performs sedation and airway monitoring; standard ASA monitoring is used and medication titrated to provide patient immobility and comfort while maintaining spontaneous ventilation. Post-procedure, the patient is observed in phase I recovery for pain control, assessment for hematuria or infection, and discharge instructions for stone passage and follow-up.

Coding Specifications

Modifier	Description	When to Use
`23`	Unusual anesthesia	Use when anesthesia is required for a procedure that normally does not require general anesthesia or deep sedation.
`52`	Reduced services	Use when anesthesia services are partially reduced or abbreviated at the physician's discretion.

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Taxonomy Code	Specialty	Notes
`207L00000X`	Anesthesiology	Physician anesthesiologists provide MAC, general or regional anesthesia for ESWL.
`367500000X`	Certified Registered Nurse Anesthetist	CRNAs frequently provide sedation and monitored anesthesia care for lithotripsy cases.
`207U00000X`	Urology	Urologists perform ESWL and coordinate procedural and postoperative care.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`N20.0`	Calculus of kidney	Indicates renal stone disease targeted by ESWL; common indication for the procedure.
`N20.1`	Calculus of ureter	Ureteral stones that may be treated with ESWL depending on size and location.
`N20.2`	Calculus of kidney with calculus of ureter	Concurrent renal and ureteral calculi; ESWL may address stones in both locations.
`N20.9`	Urinary calculus, unspecified	Non-specific stone diagnosis that may be clarified on imaging; supports medical necessity for ESWL.
`Z48.89`	Encounter for other specified surgical aftercare	Used for postoperative or follow-up visits related to stone treatment and recovery after ESWL.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`50590`	Lithotripsy, extracorporeal shock wave	The primary procedural code describing ESWL for renal or ureteral calculi; anesthesia code `00872` is reported for anesthetic services during this procedure when patient is partially submerged.
`99100`	Anesthesia for patient of extreme age, under 1 year and over 70	Report when the patient meets age criteria and qualifies for age-related anesthesia billing add-on during ESWL.
`99135`	Anesthesia complicated by utilization of controlled hypotension	Report if controlled hypotension is used as a complicating anesthesia factor during the lithotripsy.
`99140`	Anesthesia complicated by emergency conditions	Report when unexpected emergency conditions arise requiring additional anesthesia management during or immediately before/after ESWL.

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