CPT 00454: Anesthesia for Clavicle Biopsy
CPT code 00454 denotes anesthesia services for a biopsy of the clavicle (collarbone). This code is used by anesthesia providers to report perioperative anesthetic care for patients undergoing diagnostic biopsy of the clavicle, a procedure that typically occurs in hospital operating rooms or ambulatory surgical centers. Accurate use of this code is important for consistent national reporting of anesthesia utilization and for coordination between surgical and anesthesia billing.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, common service settings, and related procedural coding to help interpret usage patterns. The publication also outlines typical modifiers and provider taxonomies associated with this anesthesia service and provides ICD-10 diagnoses commonly linked to ophthalmic procedures when present in the input data.
This summary delivers actionable reference material for coding, billing review, and policy teams seeking to align anesthesia service documentation with payer requirements and national billing conventions. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 00454 describes anesthesia services provided for a biopsy procedure on the clavicle (collarbone). The service involves administration and management of anesthesia throughout the biopsy procedure to ensure patient comfort and physiological stability.
Service type: Anesthesia for clavicle biopsy
Typical site of service: Hospital operating room or ambulatory surgical center, depending on clinical complexity and facility resources.
Clinical & Coding Specifications
Clinical Context
A 68-year-old patient with progressive shoulder pain and a small palpable lesion over the clavicle is scheduled for a diagnostic excisional biopsy of the clavicle under monitored anesthesia care. The surgical team includes an orthopedic surgeon performing a limited open biopsy of the clavicular cortex with local infiltration and possible bone curettage. The anesthesiology team evaluates the patient preoperatively, documents ASA physical status, reviews medications and allergies, and obtains informed consent for anesthesia. Typical intraoperative workflow includes placement of standard monitors, IV access, administration of sedation and analgesia (or general endotracheal anesthesia if indicated), continuous hemodynamic and respiratory monitoring, and readiness to convert to a deeper anesthetic if surgical complexity increases. Postoperative handoff to PACU includes pain control plan, neurovascular assessment of the operative limb, wound care instructions, and documentation of anesthetic agents, airway management, and any intraoperative events. Typical clinical setting is an outpatient ambulatory surgery center or hospital operating room depending on comorbidities and complexity.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when anesthesia involves substantially greater effort or resources than typical for a clavicle biopsy due to complexity or prolonged duration. |
23 | Unusual anesthesia | Use when an unusual circumstance requires general anesthesia for a procedure normally performed with sedation or regional anesthesia. |
50 | Bilateral procedure | Use if bilateral clavicle procedures are performed during the same operative session. |
52 | Reduced services | Use when the planned anesthesia service is partially reduced or not completed as originally intended. |
53 | Discontinued procedure | Use when the procedure is terminated before anesthesia completion for patient or surgical reasons. |
62 | Two surgeons | Use when two surgeons perform distinct surgical parts requiring concurrent anesthesia management (rare for clavicle biopsy). |
78 | Unplanned return to the operating room following initial procedure | Use when patient requires immediate return to OR for complications related to the biopsy under the same anesthesia episode. |
AA | Anesthesia services performed personally by anesthesiologist | Use when an MD/DO anesthesiologist personally performs the anesthesia service. |
AD | Medical supervision by a physician; more than four concurrent anesthesia procedures | Use when a physician supervises multiple concurrent anesthesia cases exceeding usual staffing. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery (Note: AS is sometimes used differently in some systems) | Use when an advanced practitioner provides monitored anesthesia care or assists per facility policy. |
QK | Medical direction of two, three, or four CRNAs/AA by physician | Use when the anesthesiologist medically directs multiple CRNAs/AAs during this case. |
QS | Monitored anesthesia care service by a physician or CRNA | Use when the service provided is specifically monitored anesthesia care. |
QX | CRNA service with medical direction by a physician | Use when a CRNA furnishes the anesthesia under physician direction. |
QY | Medical direction of one CRNA by a physician | Use when the anesthesiologist medically directs a single CRNA for the case. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Anesthesiology | Physician anesthesiologists who personally deliver or direct anesthesia services for biopsies of the clavicle. |
207LA0401X | Anesthesiology Assistant | Anesthesiology assistants who function under physician supervision to provide intraoperative anesthesia care. |
367500000X | Certified Registered Nurse Anesthetist | CRNAs who provide or are medically directed to deliver anesthesia services for this procedure. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
H25.9 | Unspecified age-related cataract | Provided diagnosis from input; ophthalmic diagnosis not directly related to clavicle biopsy but may appear in the patient's problem list and affect perioperative visual status and consent processes. |
H26.9 | Unspecified cataract | As above, present in input; may be part of comorbid conditions documented during preoperative evaluation. |
H52.4 | Presbyopia | Vision-related diagnosis included in input; relevant to preoperative assessment of baseline vision but not causative for clavicular biopsy. |
H53.8 | Other visual disturbances | Included in input; documents visual symptoms that may influence postoperative instructions and safety counseling. |
H54.8 | Legal blindness, as defined in USA | Included in input; significant for preoperative consent process, assistance needs, and postoperative discharge planning. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
66984 | Extracapsular cataract removal with insertion of intraocular lens | Not directly related anatomically; listed as a related anesthesia service code for ophthalmic procedures — included for anesthesia coding cross-reference only. |
66982 | Complex cataract surgery with insertion of intraocular lens | See 66984 — related as an ophthalmic anesthesia reference; not used for clavicle biopsy but included in the provided related codes. |
00142 | Anesthesia for procedures on eye muscles | An ophthalmic anesthesia code included in the related list; not applicable to clavicle biopsy but may be referenced when coding anesthesia specialty services. |
00144 | Anesthesia for corneal transplant | Another ophthalmic anesthesia code from the provided list; not used for clavicle biopsy but present in the supplied related CPT set. |