Summary & Overview
CPT 00836: Anesthesia for Lower Abdominal Hernia Repair in Preterm Infants
CPT 00836 designates anesthesia services for lower abdominal hernia repairs in infants who were born preterm (less than 37 weeks gestation) and remain younger than 50 weeks gestational age at the time of surgery. This code fills a specific clinical and billing niche by identifying anesthesia for procedures not otherwise classified under other pediatric or infant anesthesia codes. Nationally, precise coding for high-risk neonates and young infants is important for ensuring appropriate clinical documentation, payer adjudication, and care coordination in perioperative settings.
Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will find a concise explanation of the code’s clinical scope, typical site of service, relevant diagnosis pairings, comparable anesthesia codes for related procedures, and common modifier usage for anesthesia physical status. The publication also summarizes how the code aligns with anesthesiology and pediatric anesthesiology practice contexts. Intended takeaways include clarity on the code’s appropriate clinical application, common ICD-10 diagnoses associated with these procedures, and how this code relates to nearby anesthesia codes used for pediatric and intraperitoneal procedures. Data not available in the input.
CPT Code Overview
CPT 00836 covers anesthesia for hernia repairs in the lower abdomen when the patient is an infant born at fewer than 37 weeks gestational age and younger than 50 weeks gestational age at the time of surgery. This code applies to anesthesia care for lower abdominal hernia repair procedures that are not specified by any other anesthesia code.
Service type: Anesthesia
Typical site of service: Outpatient Hospital (POS 22)
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A full-term clinical scenario describes an infant born at fewer than 37 weeks gestational age and younger than 50 weeks gestational age presenting for elective repair of a lower abdominal hernia (for example, inguinal or umbilical hernia). The perioperative workflow includes preoperative assessment by pediatric anesthesia, review of neonatal history and current physiologic status, optimization of respiratory and thermoregulatory needs, intraoperative general anesthesia with age-appropriate monitoring and medication dosing, and postoperative recovery in a pediatric PACU or neonatal observation area. The anesthesia team documents physical status using ASA modifiers and records the procedure-specific anesthesia code 00836 for billing and clinical records.
Coding Specifications
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Modifiers
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P1–P6: Physical status modifiers (ASA patient classification) are applicable to anesthesia services, including this code for infants. Use the patientspecific ASA physical status code that reflects the infant's overall preoperative health (for example,P1for a healthy infant, up toP6for a declared brain-dead patient whose organs are being removed for donor purposes). -
Provider taxonomies
| Taxonomy Code | Specialty |
|---|---|
207L00000X | Anesthesiology |
207LA0401X | Pain Medicine (Anesthesiology) |
207LP2900X | Pediatric Anesthesiology |
Related Diagnoses
K40.20— Bilateral inguinal hernia, without obstruction or gangrene, not specified as recurrent
This diagnosis commonly indicates a bilateral inguinal hernia repair, a typical indication for lower abdominal anesthesia in infants and thus clinically relevant to 00836.
K41.90— Unilateral or unspecified femoral hernia, without obstruction or gangrene, not specified as recurrent
A femoral hernia in an infant can require surgical repair under anesthesia; this diagnosis aligns with lower abdominal hernia procedures billed with 00836.
K42.9— Umbilical hernia without obstruction or gangrene
Umbilical hernia repairs in infants are lower abdominal procedures where 00836 may be reported when the patient meets the specified gestational age criteria and the case is not described by another anesthesia code.
K43.9— Ventral hernia without obstruction or gangrene
Ventral hernia repair in the lower abdominal region can be within the clinical scope of 00836 when the procedure is not otherwise classified.
K44.9— Diaphragmatic hernia without obstruction or gangrene
Diaphragmatic hernia may involve lower thoracoabdominal considerations; when the procedure is described as a lower abdominal hernia repair in an infant and no other anesthesia code applies, 00836 may be relevant.
Related CPT Codes
| CPT Code | Description | Relationship to 00836 |
|---|---|---|
00834 | Anesthesia for hernia repairs in lower abdomen (child younger than 1 year of age) | Alternative for infants under 1 year when age and documentation fit that code rather than 00836. May be selected based on provider guidance and payer rules. |
00840 | Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy | Related/Alternative for intraperitoneal or laparoscopic lower abdominal procedures; used when the operative approach extends into intraperitoneal cavity rather than isolated hernia repair. |
Note: 00834 and 00840 are commonly considered in the same family of lower abdominal anesthesia codes and may be used as alternatives depending on the specific procedure and operative approach.
National Reimbursement Benchmarks
Across national payers, Medicare mean is lower than BUCA (average commercial): Medicare mean is not provided in the input while BUCA (average commercial) reports a mean of $155.85. Blue Cross Blue Shield, Cigna, and Aetna show higher mean allowed amounts versus BUCA, while UnitedHealth Group reports the lowest mean of $65.60.
Dispersion measured as the difference between the 75th and 25th percentiles varies notably. Cigna has one of the widest spreads (519.00 - 88.50 = 430.50), indicating high variability, followed by BCBS (410.00 - 226.00 = 184.00) and Aetna (371.00 - 40.00 = 331.00). UnitedHealth Group is the tightest (75.80 - 50.33 = 25.47), showing relatively limited rate dispersion. The table and chart below present the full breakdown of national mean rates and percentile values.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska demonstrates a pronounced rate spread for CPT code 00836, with Blue Cross Blue Shield's 75th percentile rate at $537.00 and UnitedHealth Group's 25th percentile at $72.00, resulting in a spread of $465.00. This spread is considerably larger than the national average, highlighting significant payer variation within the state. The mean rates for Alaska are generally higher than national benchmarks, especially for Blue Cross Blue Shield, which stands out as the highest payer in the state.
The table and chart below present the full breakdown of mean rates and percentile values for Aetna, Blue Cross Blue Shield, Cigna, and UnitedHealth Group in Alaska. These figures illustrate the substantial differences in reimbursement levels across payers, with Blue Cross Blue Shield consistently offering the highest rates and UnitedHealth Group the lowest.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 00836 in Alaska, with a mean rate of $419.32.
- UnitedHealth Group offers the lowest mean rate at $75.12, significantly below both the state and national averages.
- The rate spread in Alaska is notably wider than national benchmarks, indicating substantial variation between payers.
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