CPT 01404: Anesthesia for Knee Joint Surgery, Open or Arthroscopic - OpenPayer

Summary & Overview

CPT 01404: Anesthesia for Knee Joint Surgery, Open or Arthroscopic

CPT code 01404 designates anesthesia services for open or arthroscopic procedures at the knee joint, including disarticulation. This code is used when anesthesia professionals provide perioperative anesthesia care for surgical interventions involving the knee, such as total knee arthroplasty, arthroscopy, or procedures requiring disarticulation. Nationally, accurate use of this code affects billing consistency, anesthesia resource allocation, and procedural reporting across surgical specialties.

Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find an overview of clinical contexts associated with the code, common procedural pairings, and the typical sites where services occur. The publication outlines common modifiers and coding relationships, lists relevant provider taxonomies, and maps common ICD-10 diagnoses that justify use of the code.

This summary provides benchmarks for typical utilization patterns and highlights implications for perioperative documentation and coding workflow. The content is intended for clinicians, anesthesia providers, billing professionals, and policy analysts seeking concise reference information on clinical application, payer coverage scope, and administrative considerations tied to CPT code 01404.

AetnaBlue Cross Blue ShieldCigna HealthUnited HealthcareMedicareCPT 01404anesthesiaknee surgeryorthopaedicssurgical anesthesiaoperating roomambulatory surgeryperioperative care

Billing Code Overview

CPT code 01404 describes anesthesia services provided for a patient undergoing an open or arthroscopic procedure at the knee joint, including disarticulation. This service represents administration and management of anesthesia care for surgical interventions involving the knee.

Service type: Anesthesia for knee joint surgery (open or arthroscopic), including procedures involving disarticulation
Typical site of service: Hospital operating room or ambulatory surgical center performing knee joint surgery

Clinical & Coding Specifications

Clinical Context

A 68-year-old patient with end-stage osteoarthritis of the right knee (M17.11) presents for total knee arthroplasty. The patient reports progressive pain, reduced range of motion, and functional limitation despite conservative care. Preoperative evaluation by the orthopaedic surgery team documents failed nonoperative measures and indicates planned open arthroplasty of the knee. The anesthesia team (Anesthesiology Physician 207L00000X or Certified Registered Nurse Anesthetist 367500000X) conducts a pre-anesthesia assessment, documents airway and medical comorbidities, and obtains informed consent for general anesthesia with regional nerve block as indicated.

On the day of surgery the typical workflow includes preoperative regional block placement in a holding area or block room (if used), intraoperative monitoring and anesthesia management in the operating room during the open or arthroscopic knee procedure, emergence in the OR or PACU, and postoperative handoff to PACU nursing. Billing uses 01404 to report anesthesia for procedures at the knee joint. Perioperative documentation includes anesthesia start and stop times, ASA physical status (for example P3), any unusual services or complications, and medical necessity tied to diagnosis codes such as M17.11. Common payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare for authorization and claims submission workflows.

Coding Specifications

Related Codes

01214

CPT 01214: Anesthesia for Total Hip Arthroplasty

01652

CPT 01652: Anesthesia for Axillary-Brachial Aneurysm Procedures

01472

CPT 01472: Anesthesia for Achilles Tendon Repair

cpt-01636-anesthesia-shoulder-forequarter-amputation

CPT 01636: Anesthesia for Shoulder and Forequarter Surgical Procedures

cpt-01656-axillary-to-femoral-bypass-anesthesia

CPT 01656: Anesthesia for Axillary-to-Femoral Bypass Graft Procedure

cpt-01392-anesthesia-open-procedure-upper-tibia-fibula-patella

CPT 01392: Anesthesia for Open Upper Tibia/Fibula or Patella Procedure

cpt-01712-anesthesia-open-tenotomy-elbow-to-shoulder

CPT 01712: Anesthesia for Open Tenotomy, Elbow to Shoulder

01320

CPT 01320: Anesthesia for Knee and Popliteal Area Procedures

01215

CPT 01215: Anesthesia for Revision of Total Hip Arthroplasty

01634

CPT 01634: Anesthesia for Shoulder Disarticulation Procedures

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`AA`	Anesthesia services performed personally by anesthesiologist	Use when the physician anesthesiologist personally performs the anesthesia service without a CRNA.
`AD`	Medical supervision by a physician; more than four concurrent anesthesia procedures	Use when the anesthesiology physician supervises a CRNA for more than four cases concurrently.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals	Use when the physician directs multiple concurrent anesthesia procedures and meets medical direction documentation.
`QS`	Monitored anesthesia care (MAC) service	Use when monitored anesthesia care is provided instead of general anesthesia for the knee procedure.
`QX`	CRNA service: CRNA with medical direction by physician	Use when a CRNA performs the anesthesia service under documented medical direction by the physician.
`QY`	CRNA service: medical direction of one CRNA by anesthesiologist	Use when the anesthesiologist medically directs a single CRNA for this case.
`QZ`	CRNA service: CRNA without medical direction by a physician	Use when a CRNA performs anesthesia independently where allowed.
`62`	Two surgeons	Use when a second surgeon is required for a complex knee procedure and two-surgeon rules apply.
`78`	Return to the operating room for a related procedure during the postoperative global period	Use when the patient returns to OR for a complication related to the original knee surgery during the global period.
`50`	Bilateral procedure	Use when bilateral knee procedures are performed and modifiers for bilateral billing rules are required.
`22`	Increased procedural services	Use when anesthesia or associated services are significantly greater than usual and documentation supports unusual effort.
`23`	Unusual anesthesia	Use when emergency or unusual circumstances prevent standard preoperative evaluation and reporting.
`56`	Discontinued procedure prior to anesthesia by surgeon request	Use when the surgeon discontinues the procedure after anesthesia has begun and relevant documentation supports the termination.
`52`	Reduced services	Use when the anesthesia or surgical procedure was partially reduced or limited relative to the full procedure.
`53`	Procedure discontinued for medical reasons	Use when the procedure is terminated for patient safety or medical reasons before completion.

Taxonomy Code	Specialty	Notes
`207L00000X`	Anesthesiology Physician	Primary physician specialty performing or directing anesthesia services for `01404`.
`367500000X`	Certified Registered Nurse Anesthetist	CRNA providing anesthesia care alone or under direction; appropriate for `QX`/`QZ`/`QY` reporting.
`207X00000X`	Orthopaedic Surgery Physician	Surgeon performing knee arthroplasty/arthroscopy; documents surgical indication and procedures tied to anesthesia billing.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`M17.10`	Unilateral primary osteoarthritis, unspecified knee	Indicates primary degenerative osteoarthritis affecting one knee; common indication for knee arthroplasty requiring anesthesia.
`M17.11`	Unilateral primary osteoarthritis, right knee	Specific laterality for primary osteoarthritis of the right knee; directly supports medical necessity for right knee anesthesia and surgery.
`M17.12`	Unilateral primary osteoarthritis, left knee	Specific laterality for primary osteoarthritis of the left knee; supports left knee operative and anesthesia services.
`M17.5`	Other unilateral secondary osteoarthritis of knee	Secondary osteoarthritis due to prior injury or condition; may be an indication for surgical intervention and related anesthesia.
`Z96.651`	Presence of right artificial knee joint	Postoperative status code indicating prior right knee prosthesis; relevant for planning revision surgery and anesthesia considerations.
`Z96.652`	Presence of left artificial knee joint	Postoperative status code indicating prior left knee prosthesis; relevant for revision procedures and anesthesia management.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`27447`	Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty)	Primary orthopaedic procedure often requiring anesthesia services reported with `01404` when anesthesia is provided for a knee arthroplasty.
`20610`	Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., knee)	May be used preoperatively or diagnostically in the care pathway; anesthesia services for aspiration/injection typically billed separately if anesthesia is required.
`29881`	Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving)	Minimally invasive knee procedure that may be performed arthroscopically; anesthesia code `01404` covers anesthesia for arthroscopic knee procedures when applicable.
`29888`	Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction	Ligament reconstruction that may occur in the same operative setting; anesthesia services for these procedures are reported with `01404` when the site is the knee.