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00104
Anesthesia for Electroconvulsive Therapy Billing & Coding Guide
Code Description
CPT code 00104 describes anesthesia services provided during electroconvulsive therapy (ECT). The anesthesia provider performs the pre-anesthesia evaluation, administers anesthesia, manages the airway as appropriate, continuously monitors the patient throughout the procedure, and provides postoperative care until the patient safely recovers from anesthesia.
Electroconvulsive therapy is commonly performed to treat severe psychiatric disorders when other treatments have been ineffective or are not appropriate. Reimbursement for CPT code 00104 is based on anesthesia base units, documented anesthesia time, applicable ASA physical status modifiers, and any qualifying circumstances recognized by the payer.
When to Use CPT 00104
Report 00104 when anesthesia services are provided during electroconvulsive therapy. The anesthesia provider should document continuous care from induction through transfer to postoperative recovery.
When Not to Use CPT 00104
Do not report 00104 when anesthesia is provided for another surgical or diagnostic procedure assigned to a different anesthesia CPT code. This code should also not be reported by the physician performing the electroconvulsive therapy procedure or for moderate sedation services reported separately under CPT guidelines.
Documentation Requirements
Documentation should include the pre-anesthesia evaluation, anesthesia start and stop times, ASA physical status, medications administered, monitoring performed, airway management when applicable, patient response throughout the procedure, and the post-anesthesia evaluation. The medical record should support that anesthesia was provided specifically for electroconvulsive therapy.
Documentation Checklist
✔ Medical necessity documented
✔ Electroconvulsive therapy documented
✔ Pre-anesthesia evaluation completed
✔ Anesthesia start and stop times documented
✔ ASA physical status documented
✔ Complete anesthesia record maintained
Billing Examples
Example 1
An anesthesiologist administers general anesthesia for a patient undergoing electroconvulsive therapy to treat severe major depressive disorder. Report CPT code 00104 for the anesthesia service.
Example 2
A patient undergoes scheduled electroconvulsive therapy for treatment-resistant bipolar disorder. The anesthesia provider documents the complete anesthesia record and reports CPT code 00104.
Base Units & Reimbursement
Anesthesia reimbursement for CPT 00104 is determined using base units, anesthesia time units, and the payer's conversion factor. Additional reimbursement may be available when qualifying circumstances are documented and payer requirements are met.
Accurate documentation of anesthesia start and stop times, the patient's ASA physical status, and all anesthesia services performed is essential for proper reimbursement.
Coding & Billing Tips
Document Accurate Anesthesia Time
Record anesthesia start and stop times accurately, as anesthesia time directly affects reimbursement.
Verify the Procedure
Confirm the anesthesia service was provided specifically for electroconvulsive therapy before reporting CPT code 00104.
Maintain Complete Documentation
Ensure the anesthesia record includes the pre-anesthesia evaluation, medications administered, monitoring performed, and postoperative assessment.
Common Billing Mistakes
Reporting the Wrong Anesthesia Code
Verify the procedure performed is electroconvulsive therapy before billing CPT code 00104.
Incomplete Time Documentation
Failure to accurately document anesthesia start and stop times may reduce reimbursement or result in claim denial.
Incomplete Anesthesia Record
Missing documentation of ASA status, monitoring, medications, or postoperative evaluation may delay payment.
Applicable ICD-10-CM Diagnosis Codes
Diagnosis codes should accurately reflect the documented condition and support medical necessity. The examples below are not all-inclusive.
F33.2 – Major Depressive Disorder, Recurrent, Severe Without Psychotic Features
This diagnosis may support medical necessity when electroconvulsive therapy is performed for severe depression that has not responded to conventional treatment. Documentation should support the indication for ECT.
F31.5 – Bipolar Disorder, Current Episode Depressed, Severe, With Psychotic Features
This diagnosis may support medical necessity when electroconvulsive therapy is used to treat severe bipolar depression. Documentation should describe the patient's condition and treatment plan.
F20.9 – Schizophrenia, Unspecified
This diagnosis may support medical necessity when electroconvulsive therapy is indicated for severe schizophrenia or treatment-resistant symptoms. Documentation should support the clinical need for ECT.
Related Codes
00100 – Anesthesia for Procedures on Salivary Glands, Including Biopsy
00100 describes anesthesia services for salivary gland procedures rather than electroconvulsive therapy.
00102 – Anesthesia for Plastic Repair of Cleft Lip
00102 is reported when anesthesia is provided for cleft lip repair procedures.
00103 – Anesthesia for Procedures on Nose and Accessory Sinuses
00103 describes anesthesia services provided for procedures involving the nose and accessory sinuses.
Frequently Asked Questions
How is CPT code 00104 reimbursed?
Reimbursement is calculated using anesthesia base units, documented anesthesia time, the payer's conversion factor, and any applicable payment adjustments.
Does CPT code 00104 include anesthesia time?
Yes. Accurate anesthesia start and stop times are required because anesthesia time is included in reimbursement calculations.
Can a CRNA report CPT code 00104?
Yes. CRNAs may report CPT code 00104 when billing under applicable Medicare and commercial payer guidelines.
Is an ASA physical status modifier required?
Most payers require an ASA physical status modifier to reflect the patient's condition during anesthesia.
Can CPT code 00104 be reported for every ECT session?
Yes. Report CPT code 00104 for each medically necessary electroconvulsive therapy session in which anesthesia services are provided and documented.
Category
CPT
Typical Time
Hospital & Outpatient Facility
Base Units + Time Units
Description
Code Type
Code
00104
Electroconvulsive therapy
Anesthesia
Common Setting
