CPT 01232: Anesthesia for Upper-Thigh (High Femoral) Leg Amputation
CPT code 01232 denotes anesthesia services for an amputation of the leg at the upper two thirds of the femur (thigh). This code captures perioperative anesthetic management for major lower-extremity amputations at a high femoral level, procedures that have significant implications for clinical risk, resource use, and perioperative planning. Nationally, accurate use of this CPT code matters for clinical documentation, care coordination, and standardization of anesthesia reporting for complex orthopedic and vascular amputations.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers can expect a concise overview of coding context and clinical setting, plus discussion of typical payment considerations and how this code relates to comparable anesthesia codes for upper-leg procedures. The publication outlines clinical context for high femoral amputations, common billing modifiers and related procedure codes, and the typical sites of service where these anesthetic services occur. It also highlights related coding distinctions that affect billing workflows for major lower-extremity amputations.
The content is intended for national audiences including anesthesia providers, surgical teams, billing professionals, and payers seeking clarity on code usage, documentation needs, and coding relationships for high-thigh amputation anesthesia.
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Billing Code Overview
CPT code 01232 describes anesthesia services provided for an amputation of the leg at the upper two-thirds of the femur (thigh). The service involves perioperative anesthesia management for surgical removal of the thigh portion of the femur.
Service Type: Anesthesia for major lower extremity amputation (upper thigh/femur level)
Typical Site of Service: Inpatient or outpatient surgical suite / operating room
Clinical & Coding Specifications
Clinical Context
A 72-year-old male with end-stage peripheral vascular disease and severe osteomyelitis of the proximal femur is scheduled for a transfemoral (above-knee) amputation at the upper two-thirds of the femur. The patient has a history of bilateral knee osteoarthritis with a prior right total knee arthroplasty (Z96.651) and chronic opioid use for lower-extremity pain. Preoperative evaluation by the anesthesiology team documents coronary artery disease (ASA P3) and diabetes. Anesthesia planning includes discussion of general endotracheal anesthesia with possible peripheral nerve catheter placement for postoperative analgesia. The certified registered nurse anesthetist (CRNA) or anesthesiologist documents medical history, airway assessment, consent for anesthesia, and planned intraoperative monitoring. Intraoperatively, the anesthesia team manages induction, hemodynamic stability during major blood loss and limb removal, and coordinates with surgery for immediate stump management. Postoperatively, patients are transferred to the post-anesthesia care unit (PACU) for respiratory and hemodynamic monitoring and pain control; considerations include regional blockade continuation, anticoagulation status, and rehabilitation planning for prosthesis evaluation when healed.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when anesthesia care required substantially greater work due to complexity or complications beyond typical for amputations at the upper two-thirds of the femur. |
23 | Unusual anesthesia | Use when emergency or unusual circumstances require general anesthesia for procedures normally done under local or regional techniques. |
50 | Bilateral procedure | Use when identical procedures are performed on both lower extremities during the same operative session (rare for unilateral transfemoral amputation). |
52 | Reduced services | Use when the anesthesia service is partially reduced or not carried out as originally planned. |
53 | Discontinued procedure | Use when anesthesia is provided but the surgical procedure is started and then terminated due to patient condition. |
62 | Two surgeons | Use when two surgeons work together as primary surgeons due to complexity of the amputation or reconstruction. |
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 an anesthesiologist | Use to indicate the anesthesia service was personally performed by an anesthesiologist. |
QK | Medical direction of two, three, or four CRNAs by an anesthesiologist | Use when an anesthesiologist medically directs multiple CRNAs during the procedure. |
QS | Monitored anesthesia care (MAC) service | Use when MAC is provided for portions of the surgical event. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Anesthesiology | Physician anesthesiologists who provide perioperative anesthesia care for major limb amputations. |
207LA0401X | Pain Medicine (Anesthesiology) | Anesthesiologists subspecialized in pain management who may manage perioperative regional analgesia and nerve catheters. |
367500000X | Certified Registered Nurse Anesthetist | CRNAs who provide anesthesia services independently or under medical direction for amputations. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M17.10 | Unilateral primary osteoarthritis, unspecified knee | Indicates degenerative joint disease that may contribute to functional loss and likelihood of progressive limb dysfunction leading to consideration of major amputation in context of other pathology. |
M17.11 | Unilateral primary osteoarthritis, right knee | Documents right knee osteoarthritis; relevant when prior joint disease and pain history affect rehabilitation and prosthesis fitting after an ipsilateral amputation. |
M17.12 | Unilateral primary osteoarthritis, left knee | Documents left knee osteoarthritis; relevant for baseline mobility and postoperative rehabilitation planning. |
M17.0 | Bilateral primary osteoarthritis of knee | Notes bilateral knee degeneration impacting overall mobility and postoperative prosthetic considerations. |
Z96.651 | Presence of right artificial knee joint | Important for surgical planning and anesthesia considerations when a prior prosthesis exists on the operative side or contralateral limb. |
Z96.652 | Presence of left artificial knee joint | Same relevance as above for the left knee prosthesis and impact on rehabilitation and positioning. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
01230 | Anesthesia for Procedures on the Upper Leg (Except Knee) (open procedure) | Applicable for other open surgical procedures on the proximal femur/upper leg; used when anatomy or procedure differs from standard transfemoral amputation. |
01234 | Anesthesia for Procedures on the Upper Leg (Except Knee) (radical resection) | Used for more extensive radical resections of upper leg soft tissue or bone; may be selected when the procedure involves wider resection than a standard amputation. |