Summary & Overview
CPT 01230: Anesthesia for Open Procedures Involving Upper Two-Thirds of Femur
CPT code 01230 represents anesthesia for open procedures involving the upper two-thirds of the femur, a critical service in orthopedic surgery. This code is widely recognized across major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. The code is primarily utilized in outpatient hospital settings, reflecting the trend toward ambulatory surgical care for complex orthopedic interventions.
This publication provides a comprehensive overview of CPT code 01230, including its clinical context, typical site of service, and relevance in medical billing. Readers will gain insight into payer coverage, common billing modifiers, and associated provider taxonomies. The analysis also highlights related CPT codes and ICD-10 diagnoses frequently linked to femur procedures, offering a broader understanding of coding practices and policy updates. Benchmarks and policy considerations are discussed to inform stakeholders about current trends and requirements in anesthesia billing for orthopedic procedures. The information is designed to support healthcare professionals, administrators, and policy analysts in navigating the complexities of anesthesia coding and reimbursement.
CPT Code Overview
CPT code 01230 is used to report anesthesia services for open procedures involving the upper two-thirds of the femur. This code is classified under the anesthesia service type and is most commonly performed in an outpatient hospital setting (Place of Service 22). The procedure typically involves providing anesthesia care for surgical interventions targeting the upper portion of the femur, ensuring patient comfort and safety during complex orthopedic operations.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting to an outpatient hospital with significant knee pathology, such as unilateral primary osteoarthritis or chronic instability, requiring an open surgical procedure on the upper two-thirds of the femur. The patient may have failed conservative management and is scheduled for surgery to address the underlying condition. Anesthesia services are provided throughout the procedure, ensuring patient comfort and safety. The clinical workflow includes preoperative assessment, administration of anesthesia, intraoperative monitoring, and postoperative care in the outpatient setting.
Coding Specifications
Common Modifiers:
| Modifier Code | Description |
|---|---|
QS | Monitored anesthesia care service |
QX | CRNA service with medical direction by a physician |
- Modifier
QSis used when monitored anesthesia care is provided. - Modifier
QXis used when a Certified Registered Nurse Anesthetist (CRNA) delivers anesthesia under physician medical direction.