CPT 01360: Anesthesia for Open Procedure on Lower One-Third of Femur
CPT code 01360 represents anesthesia services provided during open surgical procedures involving the lower one third of the femur (thigh bone). This code captures anesthesia care for complex orthopedic interventions around the distal femur and thigh and is relevant for hospitals, ambulatory surgical centers, anesthesiology groups, and payers that manage payment and quality for high-acuity surgical care. Nationally, accurate use of this code affects claims processing, provider reimbursement, and aggregate measurement of anesthesia utilization for major lower-extremity surgery.
The analysis covers major commercial and public payers, including Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find clinical context for when 01360 is reported, expected sites of service, and comparisons to related anesthesia codes used for lower-extremity procedures. The publication also outlines common billing considerations and coding relationships that influence claim adjudication and grouping for perioperative services.
This summary provides benchmarks for usage and coding relationships, clarifies clinical scenarios that align with the code description, and highlights operational implications for perioperative billing workflows. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 01360 describes anesthesia services for open procedures on the lower one third of the femur (thigh bone). The service type is anesthesia for open surgical procedures of the femur. The typical site of service is an operating room or surgical suite where open orthopedic procedures on the distal femur or thigh are performed.
Clinical & Coding Specifications
Clinical Context
A 56-year-old male presents to the emergency department after a fall from a ladder with severe pain and deformity of the right distal femur. Imaging confirms an open fracture of the lower one third of the femur requiring open reduction and internal fixation. The anesthesia team evaluates the patient preoperatively, documents airway assessment, comorbid conditions (hypertension, type 2 diabetes), and obtains consent. Intraoperative management includes general endotracheal anesthesia with end-organ monitoring, vascular access, intravenous antibiotics given pre-incision, positioning to permit orthopaedic exposure of the distal femur, and postoperative handoff to the recovery unit with pain management and monitoring for neurovascular compromise.
Perioperative workflow: pre-anesthesia assessment and consent → anesthesia induction and airway management → intraoperative anesthesia maintenance and physiologic monitoring during open femoral surgery → emergence and extubation (or monitored transfer intubated if indicated) → postoperative anesthesia handoff and documentation of complications or additional anesthesia-related procedures.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when anesthesia care required substantially greater work than typical due to complexity or severity. |
23 | Unusual anesthesia | Use when general anesthesia is administered in an unusual circumstance where regional/local is normally expected. |
50 | Bilateral procedure | Use when identical procedures are performed bilaterally in same session and anesthesia is billed accordingly. |
52 | Reduced services | Use when anesthesia service is partially reduced or abbreviated. |
53 | Discontinued procedure | Use when anesthesia was started but procedure terminated for reasons unrelated to patient choice. |
54 | Surgical care only | Use when the anesthesiologist provides only intraoperative anesthesia and not pre/postoperative anesthetic care (billing split). |
55 | Postoperative management only | Use when the anesthesiologist provides only postoperative care. |
56 | Preoperative management only | Use when only preoperative anesthesia evaluation/management is provided. |
62 | Two surgeons | Use when two surgeons work together as primary surgeons; can affect anesthesia billing context. |
78 | Unplanned return to OR | Use when patient returns to operating room for related procedure during global period. |
AA | Anesthesia by physician | Use to indicate anesthesia personally performed by an anesthesiologist. |
AD | Medical supervision by physician; more than four concurrent anesthesia procedures | Use when an anesthesiologist supervises multiple CRNAs concurrently. |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist service | Use when regional anesthesia or related anesthesia service performed by qualifying non-physician under supervision. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Anesthesiology Physician | Physician specialty credential for anesthesiologists billing and supervising anesthesia care. |
367500000X | Certified Registered Nurse Anesthetist | CRNA taxonomy for advanced practice providers delivering anesthesia under appropriate state and payer rules. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
S42.301A | Fracture of unspecified part of right humerus, initial encounter for closed fracture | Represents a proximal upper-extremity fracture; included in dataset though anatomically distinct from femur—relevant if multiple injuries or coding crosswalks are needed. |
S42.302A | Fracture of unspecified part of left humerus, initial encounter for closed fracture | As above for left side; may indicate multisite trauma requiring coordinated anesthesia care. |
M25.521 | Pain in right elbow | Symptom code that may co-occur when upper-extremity fractures or contusions are present during trauma evaluation. |
M25.522 | Pain in left elbow | Symptom code corresponding to left-sided elbow pain; relevant for comprehensive preoperative assessment. |
M77.10 | Lateral epicondylitis, unspecified elbow | Chronic elbow condition that may be present in the patient's history; relevant to perioperative pain management and positioning. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
01810 | Anesthesia for open or surgical arthroscopic procedures on knee joint | Related lower-extremity regional anesthesia techniques or comparative anesthesia codes for adjacent joint surgeries; may be referenced when procedures extend toward the knee. |
01400 | Anesthesia for open or surgical arthroscopic procedures on knee joint | Alternative anesthesia code for knee procedures; relevant when documentation must distinguish femur-only versus knee joint involvement. |
20610 | Arthrocentesis, aspiration and/or injection into a joint or bursa | May be performed pre- or postoperatively for diagnostic or therapeutic joint management adjacent to femoral surgery. |
24357 | Arthroplasty, elbow; with distal humeral prosthetic replacement | Provided as a related orthopaedic procedural code in the dataset; not directly related anatomically but represents complex joint replacement procedures that have analogous anesthesia considerations. |