Summary & Overview
CPT 01636: Anesthesia for Procedures on the Shoulder and Axilla
CPT code 01636 represents anesthesia services for procedures on the shoulder and axilla, a critical component in surgical care for patients undergoing operations in these regions. This code is widely recognized across major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, ensuring broad coverage and reimbursement for providers delivering these specialized anesthesia services.
The publication provides a comprehensive overview of 01636, detailing its clinical context, typical site of service, and its role within the broader anesthesiology service line. Readers will gain insight into payer coverage, common billing modifiers such as QS and QX, and associated provider taxonomies. Additionally, the article highlights relevant ICD-10 diagnoses frequently linked to procedures requiring anesthesia in the shoulder and axilla, such as atherosclerosis and peripheral vascular disease. Related CPT codes are also discussed to clarify distinctions in anesthesia billing for similar procedures.
This summary equips healthcare professionals, billing specialists, and policy analysts with the latest benchmarks and policy updates surrounding 01636, supporting accurate coding and understanding of its national significance in surgical anesthesia care.
CPT Code Overview
CPT code 01636 is used to report anesthesia services for procedures performed on the shoulder and axilla. This code falls under the anesthesiology service type and is most commonly utilized in the inpatient hospital setting (Place of Service 21). The code is essential for accurately documenting and billing anesthesia care provided during surgical interventions involving the shoulder and axillary regions.
Clinical & Coding Specifications
Clinical Context
A patient is admitted to an inpatient hospital (Place of Service 21) for a surgical procedure involving the shoulder or axilla. The patient may have underlying vascular conditions such as peripheral vascular disease or atherosclerosis, which necessitate surgical intervention. An anesthesiologist or a certified registered nurse anesthetist (CRNA) provides anesthesia services for the procedure, ensuring the patient is safely sedated and pain-free throughout the operation. The clinical workflow includes preoperative assessment, administration of anesthesia, intraoperative monitoring, and postoperative care.
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. Used when a CRNA provides anesthesia under the supervision of a physician.
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207L00000X |