CPT 01390: Anesthesia for Closed Procedures of Upper Tibia/Fibula/Patella
CPT code 01390 designates anesthesia services for any closed procedure involving the upper end of the tibia, fibula, and/or the patella. This code captures perioperative anesthesia care for closed knee-region interventions such as closed reductions, arthroscopic maneuvers that address the upper tibia/patella region, and other non‑open procedures focused on the proximal tibia/fibula or patella. It matters nationally because anesthesia billing for musculoskeletal procedures constitutes a substantial portion of perioperative service claims and influences facility staffing, resource allocation, and anesthesia practice patterns.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise overview of the code's clinical scope and billing context, comparisons to related anesthesia codes for knee and popliteal area procedures, and the typical settings where this service is furnished. The publication highlights common diagnostic contexts such as primary osteoarthritis, medial collateral ligament sprains, and chronic knee instability that often accompany use of this code. It also notes related CPT anesthesia codes for diagnostic arthroscopy and open procedures of the same anatomic region to clarify coding distinctions. The content is intended to inform coding staff, revenue leaders, and clinicians about clinical applicability, coding relationships, and the payer mix relevant to national billing practices.
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Billing Code Overview
CPT code 01390 describes anesthesia services provided for a patient undergoing any closed procedure of the upper end of the tibia, fibula, and/or the patella. This service typically supports procedures focused on the knee region, performed without creating an open surgical wound.
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Service type: Anesthesia for closed procedures of the upper tibia/fibula/patella
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with chronic right knee pain from longstanding primary osteoarthritis (M17.11) presents for an orthopedic closed procedure addressing tibial plateau subchondral cyst debridement and percutaneous fixation of an associated tibial fracture fragment. Preoperative evaluation by the anesthesia team documents medical history, medications, airway assessment, and ASA physical status P2 for controlled hypertension. The patient is brought to an ambulatory surgery center (typical site of service) where the orthopedist performs a closed reduction and percutaneous fixation of the upper tibia and patella fragment under fluoroscopic guidance. The anesthesia provider (an anesthesiologist or Certified Registered Nurse Anesthetist) administers monitored general anesthesia with endotracheal intubation and intraoperative hemodynamic management, including regional block supplementation as indicated. Postoperative handoff includes documentation of anesthesia technique, intraoperative events, estimated blood loss, and postoperative pain plan before transfer to the PACU for recovery and same-day discharge if stable.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
23 | Unusual Anesthesia | Use when emergency conditions require general anesthesia for a procedure usually done with local/monitored anesthesia. |
50 | Bilateral Procedure | Use when identical closed procedures are performed on both right and left sides during the same anesthetic. |
52 | Reduced Services | Use if the planned closed procedure on the tibia/patella is partially completed or reduced in scope. |
53 | Discontinued Procedure | Use when the procedure is started but terminated for patient safety before completion. |
54 | Surgical Care Only | Use when the anesthesiologist provides only intraoperative care and another clinician provides pre/postoperative anesthesia care. |
55 | Postoperative Care Only | Use when the anesthesiologist provides only postoperative anesthetic management. |
62 | Two Surgeons | Use when two surgeons from different specialties perform distinct portions of the closed procedure requiring two surgical teams. |
78 | Return to OR for Related Procedure During Global Period | Use when the patient returns to the operating room for a related closed procedure on the tibia/patella during the global period. |
AA | Anesthesia by Anesthesiologist | Use to identify anesthesia services personally performed by a physician anesthesiologist. |
QK | Medical Direction by CRNA with Qualified Anesthesiologist | Use when an anesthesiologist medically directs multiple CRNAs for this procedure. |
QS | Monitored Anesthesia Care Service | Use when monitored anesthesia care is provided instead of general/regional anesthesia. |
QX | CRNA Service with Medical Direction by Physician | Use when a CRNA performs the service under physician supervision meeting medical direction criteria. |
QY | Medical Direction of One CRNA by One Anesthesiologist | Use when the anesthesiologist directs only one CRNA for the case. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Anesthesiology | Physician anesthesiologists who typically provide anesthesia for tibial/patellar closed procedures. |
367500000X | Certified Registered Nurse Anesthetist | CRNAs who commonly deliver anesthesia in ambulatory and hospital settings for these procedures. |
207RA0401X | Anesthesiology Assistant | Anesthesiology assistants who work under physician supervision to provide anesthetic care. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M17.11 | Unilateral primary osteoarthritis, right knee | Common degenerative indication for closed interventions around the tibia/patella due to pain and joint degeneration. |
M17.12 | Unilateral primary osteoarthritis, left knee | Same as above, applicable to the contralateral knee when intervention targets the left tibial/patellar region. |
S83.241A | Sprain of medial collateral ligament of right knee, initial encounter | Acute ligamentous injury that may require closed reduction, fixation, or adjunct procedures involving the proximal tibia/patella. |
S83.242A | Sprain of medial collateral ligament of left knee, initial encounter | Contralateral MCL sprain with similar implications for closed procedures around the tibia/patella. |
M23.50 | Chronic instability of knee, unspecified knee | Chronic instability can lead to procedures addressing osseous or soft-tissue contributors near the upper tibia or patella that require anesthesia covered by this code. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
01382 | Anesthesia for procedures on the knee and popliteal area – provider performs anesthesia services for a diagnostic arthroscopic procedure of the knee joint. | Used when an arthroscopic diagnostic or therapeutic knee procedure is performed in the same surgical episode instead of or in addition to closed tibial/patellar work. |
01392 | Anesthesia for procedures on the knee and popliteal area – provider performs anesthesia services for any open procedure of the upper ends of the tibia, fibula, and/or the patella. | Applies when the planned procedure is converted to or performed as an open procedure on the proximal tibia/fibula/patella rather than a closed technique. |
01380 | Anesthesia for procedures on the knee and popliteal area – provider performs anesthesia services for any closed procedure of the knee joint. | Related for closed procedures confined to the knee joint; choose 01390 when the closed procedure specifically involves the upper tibia, fibula, and/or patella. |