00104
Anesthesia for Electroconvulsive Therapy Billing & Coding Guide
Code Description
CPT code 00104 is used for anesthesia services provided during electroconvulsive therapy (ECT).
ECT is performed under general anesthesia. The anesthesia professional evaluates the patient before treatment, administers anesthetic medications, manages ventilation and the airway as necessary, monitors the patient's physiologic status, and oversees recovery from anesthesia.
CPT 00104 represents the anesthesia service associated with ECT. It does not represent the ECT treatment itself. The procedure and anesthesia services should therefore be distinguished when coding and documenting the encounter.
When to Use CPT 00104
Use CPT code 00104 when anesthesia is provided specifically for an electroconvulsive therapy treatment.
Common situations may include:
ECT for severe major depressive disorder
ECT for severe depression with psychotic features
ECT for catatonia when clinically indicated
Continuation ECT requiring anesthesia
Maintenance ECT requiring anesthesia
ECT is commonly administered as a series of treatments. Each anesthesia encounter should be separately documented and should support the service provided on that date.
When NOT to Use CPT Code 00104
Do not report CPT code 00104 when:
Electroconvulsive therapy is not performed.
Anesthesia is provided for an unrelated procedure.
Only the ECT procedure is being reported and no separately reportable anesthesia service was provided.
Documentation does not establish anesthesia administration and monitoring.
Another anesthesia CPT code more accurately describes the procedure requiring anesthesia.
A psychiatric diagnosis by itself does not support CPT 00104. Documentation must establish that the patient underwent ECT and received anesthesia for that treatment.
Documentation Requirements
Documentation should clearly support both the ECT encounter and the anesthesia service provided.
The anesthesia record should include:
Electroconvulsive therapy performed
Pre-anesthesia evaluation
Relevant medical and anesthesia history
Anesthesia plan
Anesthetic medications administered
Neuromuscular blocking medication when applicable
Airway and ventilation management
Physiologic monitoring
Anesthesia start and stop times
Patient response to anesthesia
Post-anesthesia evaluation and recovery status
Because patients may receive multiple ECT treatments, documentation from an earlier session should not replace documentation of the current anesthesia encounter.
The record should also clearly distinguish the anesthesia professional's service from the ECT procedure performed by the treating clinician.
Documentation Checklist
Before submitting CPT code 00104, confirm that the medical record includes:
✓ Electroconvulsive therapy documented
✓ Medical necessity supported
✓ Pre-anesthesia evaluation completed
✓ Anesthesia plan documented
✓ Anesthetic medications recorded
✓ Airway and ventilation management documented
✓ Physiologic monitoring documented
✓ Anesthesia start and stop times recorded
✓ Patient recovery documented
Examples
Example 1
A patient with severe recurrent major depressive disorder undergoes ECT. The anesthesia professional performs a pre-anesthesia evaluation, administers anesthesia and a neuromuscular blocking agent, manages ventilation, monitors the patient throughout treatment, and supervises recovery. CPT code 00104 is reported for the anesthesia service.
Example 2
A patient receiving a course of ECT returns for another scheduled treatment. Anesthesia is administered and the patient's ventilation and physiologic status are managed throughout the encounter. The anesthesia record includes start and stop times and recovery documentation. CPT code 00104 is reported for that anesthesia encounter.
Example 3
A patient undergoes ECT for a documented condition for which the treatment is clinically indicated. The anesthesia professional documents the pre-anesthesia assessment, medications, airway management, monitoring, anesthesia time, and postoperative recovery. CPT code 00104 may be reported for the anesthesia portion of the treatment.
Base Units & Reimbursement
Reimbursement for CPT 00104 generally follows anesthesia payment methodology and may consider the anesthesia code's base units, documented anesthesia time, and the applicable payer conversion factor.
The basic anesthesia payment calculation generally considers:
Base Units + Time Units + Applicable Additional Units
The resulting units are then applied to the applicable anesthesia conversion factor. Actual reimbursement can vary according to payer policies, geographic adjustments, provider arrangements, and other payment rules.
The duration of the ECT stimulus should not simply be reported as anesthesia time. Anesthesia time should reflect the anesthesia professional's qualifying service according to applicable billing requirements.
Coding & Billing Tips
Use CPT 00104 specifically for anesthesia associated with ECT.
Do not use CPT 00104 to report the ECT procedure itself.
Document each anesthesia encounter when ECT is performed as a treatment series.
Record anesthesia start and stop times accurately.
Select the diagnosis that reflects the condition actually being treated.
Document anesthetic medications, ventilation, monitoring, and recovery.
Do not add modifiers merely because they are commonly used with anesthesia claims; report only modifiers supported by the actual service and payer requirements.
Common Billing Mistakes
Confusing the anesthesia service with the ECT procedure
CPT 00104 represents anesthesia associated with ECT. It does not replace the code used to report the electroconvulsive therapy procedure itself.
Coding from the psychiatric diagnosis alone
A diagnosis such as major depressive disorder does not independently establish CPT 00104. The record must show that ECT was performed and anesthesia was provided for that treatment.
Failing to document each ECT session
Patients may undergo numerous ECT treatments. Each separately billed anesthesia encounter should have documentation supporting the service provided during that session.
Reporting inaccurate anesthesia time
Anesthesia time should reflect the qualifying anesthesia service rather than simply matching the duration of the electrical stimulus or another procedural time measurement.
Incomplete airway and ventilation documentation
Anesthesia for ECT commonly involves management of ventilation during the treatment. The anesthesia record should accurately document the care actually provided.
Automatically applying generic anesthesia modifiers
Provider-role modifiers should not be added simply because CPT 00104 is an anesthesia code. Any modifier reported must accurately describe the circumstances of the individual anesthesia service.
Common ICD-10-CM Codes
F33.2 – Major Depressive Disorder, Recurrent Severe Without Psychotic Features
May support the encounter when ECT is performed for documented severe recurrent major depression without psychotic features.
F33.3 – Major Depressive Disorder, Recurrent Severe With Psychotic Symptoms
May apply when ECT is performed for documented severe recurrent major depression accompanied by psychotic symptoms.
F06.1 – Catatonic Disorder Due to Known Physiological Condition
May apply when ECT is performed for documented catatonia due to a known physiological condition. The diagnosis selected must correspond to the patient's actual documented form and cause of catatonia.
Applicable Modifiers
May be reported when the anesthesia service for ECT is personally performed by an anesthesiologist. This modifier identifies the anesthesiologist's role in providing the anesthesia service.
May be reported when a CRNA provides the anesthesia service with medical direction by a physician. Documentation must support the applicable medical-direction requirements.
May be reported when a CRNA provides the anesthesia service without medical direction by a physician. Use depends on the actual anesthesia arrangement and payer requirements.
Only report a modifier when the circumstances of the individual claim support its use.
Related CPT Codes
90870
CPT 90870 is the most directly related procedure code because it represents the electroconvulsive therapy treatment for which CPT 00104 provides the associated anesthesia service.
00100 – Anesthesia for Salivary Gland Procedures
A broader related anesthesia code within the same head anesthesia code family. It can provide a useful internal link for users comparing anesthesia code selection.
00102 – Anesthesia for Cleft Lip Repair
Another nearby head anesthesia code covering a different underlying procedure. It is useful for navigating related anesthesia coding guidance while remaining clearly distinguished from ECT anesthesia.
FAQ
What is CPT code 00104 used for?
CPT code 00104 is used to report anesthesia services provided during electroconvulsive therapy.
Does CPT 00104 include the electroconvulsive therapy procedure?
No. CPT 00104 represents the anesthesia service associated with ECT. The ECT procedure itself is separately represented by CPT 90870.
Can CPT 00104 be reported for each ECT treatment?
When anesthesia is provided during multiple ECT treatments, CPT 00104 may be reported for each qualifying anesthesia encounter when the documentation and payer requirements support the service.
What should be documented for CPT 00104?
Documentation should support the pre-anesthesia evaluation, anesthesia plan, medications administered, airway or ventilation management, physiologic monitoring, anesthesia time, patient response, and recovery.
How is CPT 00104 reimbursement calculated?
Reimbursement generally follows anesthesia payment methodology and may consider base units, documented anesthesia time, the applicable conversion factor, and payer-specific payment rules.
Are there specific modifiers for CPT 00104?
There are no modifiers specifically tied to ECT anesthesia represented by CPT 00104. General anesthesia modifiers may apply based on the circumstances of the service and payer requirements.
Category
CPT
Typical Time
Hospital & Outpatient Facility
Base Units + Time Units
Description
Code Type
Code
00104
Electroconvulsive therapy
Anesthesia
Common Setting
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