CPT 01234: Anesthesia for Radical Resection of Upper Two Thirds of Femur
CPT code 01234 denotes anesthesia services for a radical resection of the upper two thirds of the femur, a major orthopedic procedure involving extensive tissue removal. Nationally, this code is relevant for hospitals and surgical centers that provide complex lower‑extremity oncology or trauma resections and for anesthesia providers documenting high‑acuity intraoperative care. Proper coding of these services supports clinical documentation, resource allocation, and payer adjudication for major procedures.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise review of the clinical context for the service, common payer coverage patterns, typical sites of service, and practical billing considerations such as related procedure coding and how this anesthesia code aligns with major orthopedic service lines. The publication also highlights associated service lines and related anesthesia codes to aid coding accuracy.
This summary focuses on a national perspective, clarifying what the code represents, why it matters for surgical and anesthesia teams, and what to expect in terms of clinical and billing alignment for major femoral resections. Data not available in the input will be noted where applicable in detailed sections.
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Billing Code Overview
CPT code 01234 describes anesthesia services provided for a patient undergoing a radical resection of the upper two thirds of the femur (thigh bone). This code applies when anesthesia is administered for extensive surgical removal of tissue from the proximal and mid portions of the femur.
Service type: Anesthesia for major orthopedic surgery
Typical site of service: Inpatient or outpatient surgical suite / operating room
Clinical & Coding Specifications
Clinical Context
A 68-year-old ambulatory patient with progressive right hip and proximal femoral pain from advanced osteoarthritis is scheduled for a radical resection of the upper two-thirds of the right femur (radical femoral resection) for severe degenerative disease with failed conservative care. Preoperative evaluation is performed by the anesthesia team including an anesthesiologist and a certified registered nurse anesthetist. The patient has comorbid hypertension and controlled type 2 diabetes and an American Society of Anesthesiologists physical status of P3.
On the day of surgery the patient arrives to an orthopedic operating room at an inpatient hospital. Standard monitoring is applied, including arterial line access for hemodynamic monitoring given anticipated blood loss. General endotracheal anesthesia is induced for surgical exposure and oncologic-style or extensive resection of the proximal femur, with planned intraoperative transfusion if needed. The anesthesia team documents start and stop times for anesthesia services, communicates with the orthopaedic surgeons regarding intraoperative positioning and blood loss, and coordinates postoperative analgesia and transfer to the post-anesthesia care unit (PACU) and then to an inpatient orthopedic ward for recovery and rehabilitation.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work required is substantially greater than typical due to complexity or extensiveness of the femoral resection. |
23 | Unusual anesthesia | Use when emergency anesthesia is provided for an emergency procedure. |
50 | Bilateral procedure | Use when identical extensive procedures are performed on both femora (rare for this code). |
52 | Reduced services | Use when the procedure is partially reduced or not completed as planned. |
53 | Discontinued procedure | Use when the procedure is started but terminated for reasons unrelated to patient improvement. |
55 | Postoperative management only | Use when only postoperative anesthesia management is billed separately. |
56 | Preoperative services only | Use when only preoperative anesthesia evaluation is billed separately. |
62 | Two surgeons (same specialty) | Use when two surgeons of the same specialty assist due to procedure complexity. |
78 | Unplanned return to the operating room | Use for anesthesia services for a return to the OR related to the initial procedure during the global period. |
AA | Anesthesia by physician | Use when physician anesthesiologist personally performs the anesthesia care. |
AD | Medical supervision by physician; more than four concurrent anesthesia procedures | Use when the anesthesiologist supervises multiple concurrent anesthesia providers. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for anesthesia | Use when these clinicians provide anesthesia services as recognized by payer policies. |
QK | Medical direction of two, three, or four qualified individuals | Use when the anesthesiologist medically directs multiple CRNAs under specific payer rules. |
QX | CRNA service: CRNA with medical direction by a physician | Use when a CRNA furnishes the service under physician direction as documented. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Anesthesiology | Physician anesthesiologists providing general/regional anesthesia for major orthopedic resections. |
367500000X | Certified Registered Nurse Anesthetist | CRNAs administering anesthesia in hospital or ambulatory surgical settings for femoral resections. |
207X00000X | Orthopaedic Surgery | Orthopaedic surgeons performing radical femoral resections and intraoperative management. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M17.10 | Unilateral primary osteoarthritis, unspecified knee | Osteoarthritis contributes to lower extremity degenerative disease; may be part of multisite joint disease prompting proximal femoral surgery planning. |
M17.11 | Unilateral primary osteoarthritis, right knee | Documented right-sided knee osteoarthritis may coexist with ipsilateral hip/proximal femoral pathology affecting surgical planning and rehabilitation. |
M17.12 | Unilateral primary osteoarthritis, left knee | Documented left-sided knee osteoarthritis may coexist with femoral pathology and impact postoperative mobility and therapy. |
Z96.651 | Presence of right artificial knee joint | Presence of a right knee prosthesis is relevant for positioning, imaging, and perioperative infection risk assessment. |
Z96.652 | Presence of left artificial knee joint | Presence of a left knee prosthesis informs perioperative planning, positioning, and potential prosthesis-related considerations. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
01232 | Anesthesia for open procedures involving upper two‑thirds of femur; amputation | Closely related anesthesia code for open proximal femoral procedures or amputation; may be used for similar anatomic level or variant surgical approaches. |