Summary & Overview
CPT 01274: Anesthesia for Upper Leg Artery Procedures, Bypass Graft & Embolectomy
CPT code 01274 covers anesthesia for procedures involving the arteries of the upper leg, including bypass grafts and femoral artery embolectomy. This code is significant for hospitals and providers specializing in vascular and orthopedic surgery, as it ensures proper billing and reimbursement for complex inpatient procedures requiring advanced anesthesia care. Nationally, the code is recognized by major commercial payers such as Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, reflecting its widespread applicability across diverse healthcare settings.
This publication provides a comprehensive overview of CPT code 01274, including payer coverage, clinical context, and relevant benchmarks. Readers will gain insight into the typical site of service, associated service lines, and the importance of accurate coding for inpatient vascular procedures. Policy updates and billing considerations are also discussed, helping stakeholders understand the evolving landscape of anesthesia reimbursement. The analysis includes comparisons to related CPT codes and highlights common modifiers used in billing, offering a clear picture of how this code fits within broader anesthesiology and surgical practices.
CPT Code Overview
CPT code 01274 is used to report anesthesia services for procedures involving the arteries of the upper leg, specifically including bypass graft and femoral artery embolectomy. This code falls under the anesthesiology service type and is typically performed in an inpatient setting, as it is designated as an inpatient-only procedure. The code is relevant for cases where specialized anesthesia care is required during complex vascular interventions in the upper leg.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult patient admitted to the hospital for an urgent femoral artery embolectomy due to acute limb ischemia. The patient may have a history of knee osteoarthritis or previous knee replacement, as indicated by the associated ICD-10 codes. The clinical workflow includes preoperative assessment by the anesthesiology team, administration of anesthesia for the surgical removal of an embolus from the femoral artery, and postoperative monitoring in an inpatient setting. The procedure is performed by a vascular or orthopedic surgeon, with anesthesia provided by an anesthesiologist or a certified registered nurse anesthetist (CRNA), often under medical direction.
Coding Specifications
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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 services under the medical direction of a physician.
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Provider Taxonomies:
Taxonomy Code Specialty Name