Anesthesia administration is a service used in almost all specialty practices. The reimbursement amounts for anesthetic codes are also high. That’s why healthcare providers cannot afford to get these claims wrong. Otherwise, they can lose a lot of revenue.
CPT code 00840 is frequently used in anesthesia billing. However, its reimbursement calculation is complex and trips up many billers. That’s why we have included this code in our ‘CPT Codes’ series. So, let’s start.
CPT Code 00840 – Description
CPT code 00840 is defined as:
“Anesthesia for intraperitoneal procedures in the lower abdomen, including laparoscopy; not otherwise specified.”
Let’s clarify this code in more detail. CPT code 00840 is part of the anesthesia code series (00100-01999) of the CPT manual. This code is used for providing anesthesia services during lower abdomen surgical procedures, including laparoscopy.
What’s important to note here is that code 00840 is listed in the “not otherwise specified” category, which means that it does not cover a specific service or situation. Rather, it should only be used when no more specific anesthesia code accurately describes the procedure being performed.
00840 is assigned 6 base units, which reflects the complexity and the resources required during its administration.
Scenarios Where CPT Code 00840 is Applicable
To help you understand better, we have explained below a couple of real-world scenarios in which CPT code 00840 can be used:
Laparoscopic Hernia
Suppose a 40-year-old man has persistent groin pain and some bulging in the inguinal area. He works as a construction laborer and experiences difficulty in physical activity. The physician diagnoses an incarcerated inguinal hernia. As a treatment, the physician orders a laparoscopic hernia repair under anesthesia.
During the surgery, anesthesia is provided by a professional anesthesiologist. After a successful surgery, the biller can file an insurance claim using a valid surgery code and CPT code 00840, along with the appropriate modifier.
Tubal Ligation
Let’s look at another example. Imagine that a patient requesting permanent sterilization after multiple pregnancies visits the gynecology clinic. The patient is between 30 and 40 years of age and has a history of uncomplicated deliveries. The attending physician recommends tubal ligation to block the fallopian tubes and prevent conception.
A laparoscopic tubal ligation is performed under anesthesia. The surgeon accesses the abdomen via small incisions, applying clips to occlude the tubes, and the results show effective sterilization without issues. In this case, CPT code 00840 can be used to bill the anesthesia service.
Applicable Modifiers for CPT Code 00840
Modifiers are a vital part of insurance claims. They provide information about the circumstances in which a procedure was performed. Appending modifiers becomes even more essential in cases of unspecified CPT codes, such as 00840. The following are some of the most commonly used modifiers with CPT code 00840:
| Modifier | Description |
|---|---|
| AA | An anesthesia procedure performed by the anesthesiologist. |
| QK | Medical direction of 2 to 4 simultaneous anesthesia cases by a qualified professional. |
| QY | Medical direction of one CRNA by an anesthesiologist |
| QX | A CRNA administers anesthesia under the guidance of a physician. |
| QZ | A CRNA administers anesthesia without physician supervision. |
*CRNA stands for Certified Registered Nurse Anesthetist.
Anesthesia codes are slightly different from other CPT codes. These codes must always be reported with a physical status modifier (P1-P6). The following is a simple breakdown of these modifiers:
| Modifier | Patient Status | Physical Status Units |
|---|---|---|
| P1 | Normal healthy patient. | 0 |
| P2 | Patient with mild systemic disease. | 0 |
| P3 | Patient with severe systemic disease. | 1 |
| P4 | Patient with severe systemic disease that is a constant threat to life. | 2 |
| P5 | Moribund patient not expected to survive without an operation. | 3 |
| P6 | A brain death patient whose organs are being removed for donation. | 0 |
Source: American Society of Anesthesiologists
CPT Code 00840 – Billing & Reimbursement Guidelines
Anesthesia billing codes, and specifically CPT code 00840, require attention to detail. The following are some points to keep in mind while filing claims.
Reimbursement Calculation
For code 00840 and other anesthesiology codes, you will have to calculate the reimbursement amount yourself before filing the claims. By doing this, you can guarantee receiving fair reimbursement for your services. Reimbursement is calculated via the following formula:
Payment = (Base Units + Time Units + Physical Status Units) × Conversion Factor
Let’s simplify this for you by doing an example calculation.
Suppose the anesthesia specialist spends around 90 minutes during hernia surgery. The time calculation begins when the provider starts patient preparation and ends when the patient is no longer under the care. So, according to the 15-minute rule, the time units are calculated as:
Time Units = 90 minutes/ 15 minutes = 6
We have already discussed that CPT code 00840 has 6 base units. For the physical status indicator, let’s take P1 for our scenario. So, the following are the summarized values for our variables:
- Base Units = 6
- Time Units = 6
- Physical Status Units = 0
The value of the conversion factor varies across providers and their states and localities. For our scenario, let’s set the conversion factor value at $20.24. So, the final reimbursement amount will be:
Payment = (6+6+0) x $20.24
Payment = $242.88
You can get the Medicare conversion factors for your area via their guide.
Documentation Requirements
Proper documentation for CPT code 00840 must include:
- Anesthesia Start and End Times: Precise documentation of when anesthesia care begins and ends.
- Physical Status Assessment: Clear justification for the P-modifier selected.
- Procedure Description: Detailed description of the surgical procedure requiring anesthesia.
- Provider Role Documentation: Clear indication of anesthesia provider roles (physician vs. CRNA, supervision vs. direction).
- Complications or Unusual Circumstances: Any factors that affected the anesthesia care provided.
Wrapping Up
Let’s wrap up everything we have discussed so far. CPT code 00840 is an anesthesia billing code. It is used for lower abdomen procedures and must only be used when no specific anesthetic code is available. For reimbursement, it is vital to append the appropriate modifiers and documentation with your claims.
However, if you are facing frequent denials or lack a strong in-house billing team, you can leverage specialized anesthesia billing services provided by our expert billing consultants.
