Anesthesia Coding Alert

Question: Our anesthesiologist provided services for a 9-month old normal child who underwent hernia repair in the lower abdomen. What is the correct anesthesia code, and what modifiers apply?

Nevada Subscriber

Answer: CPT^® categorizes hernia repair codes primarily by the type of hernia (inguinal, femoral, incisional, etc). Your first step in choosing the correct surgical code is determining the type of hernia, then check for details regarding whether the hernia is classified as initial or recurrent and the clinical presentation (reducible vs. incarcerated or strangulated).

Single choice: No matter the type of hernia, you only have one choice for an anesthesia code in this case because of the patient’s age. You should report 00834 (Anesthesia for hernia repairs in the lower abdomen not otherwise specified, younger than 1 year of age). For younger infants, code 00836 (Anesthesia for hernia repairs in the lower abdomen not otherwise specified, infants younger than 37 weeks gestational age at birth and younger than 50 weeks gestational age at time of surgery) could apply instead.

Note: You can sometimes include the qualifying circumstances code +99100 (Anesthesia for patient of extreme age, younger than 1 year and older than 70 [List separately in addition to code for primary anesthesia procedure]) on claims for anesthesia procedures on infants. CPT^® instructs you to not submit +99100 with 00834, however, because 00834 is an age-specific code. The base unit value of 5 already accounts for the potential complications associated with the child’s age.