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.
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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.
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Service type: Anesthesia for knee joint surgery (open or arthroscopic), including procedures involving disarticulation
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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
| Modifier | Description | When to Use |
|---|---|---|
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. |