Summary & Overview
CPT 01212: Anesthesia for Open Hip Joint Procedures, Hip Disarticulation
CPT code 01212 represents anesthesia for open procedures involving the hip joint, specifically hip disarticulation. This code is nationally relevant due to the complexity and critical nature of hip disarticulation surgeries, which require specialized anesthesia care in hospital or surgical center operating rooms. The publication covers key payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, providing a comprehensive overview of payer coverage and policy considerations for this high-acuity service.
Readers will gain insight into the clinical context of hip disarticulation anesthesia, typical sites of service, and the importance of accurate coding for reimbursement and compliance. The summary includes benchmarks, policy updates, and related clinical information, helping stakeholders understand how this code fits within broader anesthesia billing practices. The publication also highlights common modifiers and associated provider taxonomies, offering a clear view of the coding landscape for anesthesia services in orthopedic surgery. This information is essential for healthcare professionals, billing specialists, and policy analysts seeking to stay informed about anesthesia coding and payer requirements for complex hip procedures.
CPT Code Overview
CPT code 01212 is used to report anesthesia services for open procedures involving the hip joint, specifically hip disarticulation. This code applies to cases where a patient undergoes surgical removal of the entire hip joint, typically performed in an operating room setting within an inpatient hospital or surgical center. The service type is anesthesia, and it is provided to ensure patient comfort and safety during complex orthopedic surgeries involving the hip. This procedure is significant due to its complexity and the critical role of anesthesia in facilitating successful surgical outcomes.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult undergoing an open surgical procedure for hip disarticulation, often due to severe joint disease, trauma, or malignancy. The patient is admitted to an inpatient hospital or surgical center and requires comprehensive anesthesia care throughout the operation. The clinical workflow includes preoperative assessment by an anesthesiologist or certified registered nurse anesthetist, administration of anesthesia in the operating room, continuous monitoring during the procedure, and postoperative recovery management.
Coding Specifications
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Modifiers:
QS: Monitored anesthesia care service. Used when the anesthesia provider delivers monitored anesthesia care rather than general anesthesia.QX: CRNA service with medical direction by a physician. Applied when a certified registered nurse anesthetist provides anesthesia under the medical direction of a physician.
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Provider Taxonomies:
207L00000X: Anesthesiology – represents physicians specializing in anesthesia.367500000X: Certified Registered Nurse Anesthetist – represents CRNAs who provide anesthesia services.207RA0401X: Anesthesiology Assistant – represents professionals assisting in anesthesia care under supervision.