CPT 01190: Anesthesia Services in Inpatient Hospital (Deleted Code) - OpenPayer

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Summary & Overview

CPT 01190: Anesthesia Services in Inpatient Hospital (Deleted Code)

CPT code 01190, previously used for anesthesia services in inpatient hospital settings, was deleted effective January 1, 2018. This code played a significant role in the billing and documentation of anesthesia care for complex surgical procedures, particularly those involving the pelvis and hip. The removal of CPT 01190 from the code set underscores the continual evolution of medical billing practices and the need for providers and payers to stay current with coding updates.

Blue Cross Blue Shield is the primary payer referenced in this analysis. Readers will gain insight into the historical context of CPT 01190, including its clinical applications, typical site of service, and associated modifiers such as QS for monitored anesthesia care and QX for CRNA services with physician direction. The publication also highlights related ICD-10 diagnoses and CPT codes, providing a comprehensive overview of the clinical scenarios where this code was previously utilized. Policy updates, benchmarks, and the impact of code deletion on billing practices are discussed, offering valuable information for healthcare professionals, administrators, and policy analysts.

Blue Cross Blue ShieldCPT 01190anesthesiainpatient hospitalcode deletionmedical billingclinical contextmodifiersICD-10 diagnosesrelated CPT codespolicy update

CPT Code Overview

CPT 01190 was an anesthesia code used for services provided in an inpatient hospital setting. The code was officially deleted effective January 1, 2018, and is no longer in use for current billing or clinical documentation. As an anesthesia service, it was typically associated with procedures requiring specialized care and monitoring during surgery or other interventions. The deletion of this code reflects ongoing updates to medical billing standards and the evolution of clinical practice. Data not available in the input regarding the specific procedures previously associated with this code.

Clinical & Coding Specifications

Clinical Context

A typical patient scenario involves an adult admitted to an inpatient hospital for surgical treatment of a pelvic or hip fracture. The patient may present with a fracture of the pelvis, pubis, or femoral neck, possibly due to trauma or underlying neoplastic disease. An anesthesiology physician or certified registered nurse anesthetist (CRNA) provides anesthesia services during procedures such as total hip arthroplasty or open treatment of femoral fractures. The clinical workflow includes preoperative assessment, administration of anesthesia, intraoperative monitoring, and post-anesthesia care. The service is performed in an inpatient hospital setting, with anesthesia tailored to the patient's medical condition and surgical requirements.

Coding Specifications

Modifiers:
- QS: Monitored anesthesia care service. Used when the anesthesia provider delivers monitored anesthesia care (MAC) during the procedure.
- QX: CRNA service with medical direction by a physician. Used when a CRNA provides anesthesia under the medical direction of an anesthesiology physician.
Provider Taxonomies:

Taxonomy Code Specialty Name

National Reimbursement Benchmarks

For CPT code 01190, the national mean rate for Blue Cross Blue Shield and BUCA (average commercial) is $277.22. Medicare rates are not available in the input, so a direct comparison cannot be made. The commercial mean rates are consistent across both Blue Cross Blue Shield and BUCA.

Rate dispersion, measured by the difference between the 75th and 25th percentiles, is $15.00 for both Blue Cross Blue Shield and BUCA, indicating a relatively tight range of reimbursement rates nationally for these payers. No other payer data is available for comparison.

The table and chart below present the full breakdown of national benchmarks for CPT code 01190 by payer.

State Benchmarks

State: AK1 / 50

Alaska Benchmarks

Alaska's reimbursement rates for CPT code 01190 are highly uniform, with Blue Cross Blue Shield and BUCA both reporting a mean rate of $82.29 and all percentile values at $80.00. This results in a rate spread of $0.00, indicating no variation in payment rates among providers for this code within the state. Such uniformity is uncommon and suggests a standardized approach to reimbursement for this procedure.

Compared to national averages, Alaska's rates are substantially lower. National mean rates for Blue Cross Blue Shield and BUCA are $277.22, with percentile values ranging from $250.00 to $265.00. The table and chart below present the full payer breakdown for Alaska, highlighting the stark difference between state and national reimbursement levels.

Key Insights for Alaska

Blue Cross Blue Shield and BUCA are tied as the highest and lowest paying payers in Alaska for CPT 01190, both with a mean rate of $82.29.
All percentile values (25th, 50th, 75th) are identical at $80.00, indicating no rate spread among providers in Alaska.
Alaska's mean rates are significantly lower than national averages, with a gap of nearly $195.00 compared to national BCBS and BUCA rates.

Related Codes

01140

CPT 01140: Anesthesia for Interpelviabdominal (Hindquarter) Amputation

00906

CPT 00906: Anesthesia for Perineal Procedures, Not Otherwise Specified

00921

CPT 00921: Anesthesia for Vasectomy Procedures on Male Genitalia

00920

CPT 00920: Anesthesia for Male Genital Procedures, NOS

01160

CPT 01160: Anesthesia for Pelvic Procedures (Except Hip)

00930

CPT 00930: Anesthesia for Orchiopexy, Unilateral or Bilateral

00910

CPT 00910: Anesthesia for Transurethral Procedures

01120

CPT 01120: Anesthesia for Procedures on Bony Pelvis

01150

CPT 01150: Anesthesia for Radical Pelvic Tumor Procedures

00928

CPT 00928: Anesthesia for Radical Abdominal Orchiectomy

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