CPT 01230: Anesthesia for Open Procedure of Upper Two Thirds of Femur
CPT code 01230 designates anesthesia services for open procedures of the upper two thirds of the femur. This code is used to bill perioperative anesthesia care when a patient undergoes an open surgical intervention on the proximal or midshaft femur, and it is relevant to hospitals, surgical centers, anesthesiology practices, and payers that reimburse perioperative anesthesia. Nationally, accurate use of this code supports appropriate payment for anesthesia intensity and time associated with major lower-extremity orthopedic procedures.
Key payers addressed in this publication include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise explanation of the clinical context for the code, typical sites of service, and how 01230 relates to other femur anesthesia codes. The report also summarizes common modifiers and related procedure codes to help clarify coding situations, lists associated clinical diagnoses commonly encountered with femur surgeries, and highlights linked anesthesia provider taxonomies. The content is oriented to billing professionals, anesthesiology clinicians, and revenue-cycle staff seeking a national overview of coding expectations and clinical context for anesthesia services to the upper two thirds of the femur.
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Billing Code Overview
CPT code 01230 describes anesthesia services provided for an open surgical procedure involving the upper two thirds of the femur (thigh bone). This code covers anesthetic management for procedures on the proximal and midshaft femur where an open approach is performed.
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Service type: Anesthesia for open femoral surgery
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Typical site of service: Inpatient or outpatient surgical suite where open orthopedic femur procedures are performed
Clinical & Coding Specifications
Clinical Context
A 72-year-old female with advanced osteoarthritis presents with progressive right hip/thigh pain and limited ambulation. Imaging shows destructive disease of the proximal femur requiring an open surgical procedure of the upper two thirds of the femur (for example, proximal femoral resection with reconstruction or revision arthroplasty involving the proximal femur). Preoperative evaluation by the anesthesia team documents medical history including hypertension and COPD, ASA physical status III. The clinical workflow: pre‑operative anesthesia assessment and airway evaluation in preop holding; intraoperative management in the operating room including induction, airway control, maintenance of general or regional anesthesia, invasive monitoring if indicated, intraoperative analgesia and hemodynamic management during the open femoral procedure; immediate postoperative handoff to PACU with orders for analgesia and respiratory monitoring. An anesthesiologist, certified registered nurse anesthetist, or anesthesiology assistant may provide care and bill under the applicable anesthesia taxonomy for anesthesia services during the open procedure of the upper two thirds of the femur (01230).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when anesthesia care required substantially greater work or complexity than typical for the procedure (document rationale). |
23 | Unusual anesthesia | Use when general anesthesia is administered for a procedure that normally does not require it (if applicable). |
50 | Bilateral procedure | Use when identical procedures are performed on both femurs during the same anesthetic (rare for this code). |
52 | Reduced services | Use when the anesthesia service is partially reduced or not completed as planned. |
53 | Discontinued procedure | Use when the procedure is terminated after anesthesia has been initiated. |
54 | Surgical care only | Use when the anesthesiologist is not providing postoperative anesthetic management. |
55 | Postoperative management only | Use when the anesthesiologist provides only postoperative management. |
62 | Two surgeons | Use when two surgeons work together as primary surgeons (affects surgical, but reported here if applicable by facility policy). |
78 | Unplanned return to OR | Use when the patient returns to the operating room for a related procedure during the postoperative global period. |
AA | Anesthesia by physician | Use to identify anesthesia personally performed by an anesthesiologist. |
AD | Medical supervision by physician; more than four concurrent anesthetics | Use when supervising more than four concurrent anesthesia procedures. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for qualified non‑physician anesthetist | Use when an anesthesiologist medically directs a CRNA and those supervision rules apply. |
QK | Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals | Use when the physician medically directs multiple concurrent anesthetics per CMS rules. |
QX | CRNA service: CRNA with medical direction by a physician | Use when a CRNA provides care and a physician provides medical direction consistent with Medicare rules. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Anesthesiology | Physician specialist performing or directing anesthesia care. |
367500000X | Certified Registered Nurse Anesthetist | CRNA providing anesthesia services; may bill under supervision/medical direction rules. |
207RA0401X | Anesthesiology Assistant | Anesthesiology assistant participating under physician supervision per state and payer rules. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M17.11 | Unilateral primary osteoarthritis, right knee | Degenerative joint disease that may coexist with proximal femoral pathology or indicate overall lower‑extremity joint disease; may influence perioperative mobility and pain management. |
M17.12 | Unilateral primary osteoarthritis, left knee | Same relevance as above for the contralateral knee. |
S83.241A | Sprain of medial collateral ligament of right knee, initial encounter | Acute knee ligament injury that can be associated with instability and may alter surgical positioning or postoperative rehabilitation plans. |
S83.242A | Sprain of medial collateral ligament of left knee, initial encounter | Same clinical relevance for the left knee. |
M23.50 | Chronic instability of knee, unspecified knee | Chronic knee instability affecting gait and functional status; relevant to preoperative assessment and perioperative mobilization planning. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
01232 | Anesthesia for upper two thirds of femur, amputation | Related when the surgical procedure is an amputation of the proximal femur rather than resection or other open femoral procedure; anesthesia reporting parallels 01230. |
01234 | Anesthesia for upper two thirds of femur, radical resection | Related for more extensive radical resections of the proximal femur; used when the surgical intervention is more extensive than standard open procedures covered by 01230. |