CPT 01610: Anesthesia for Shoulder and Axilla Procedures
CPT code 01610 designates anesthesia services provided for procedures targeting the nerves, muscles, tendons, fascia, and bursae of the shoulder and axilla. This code is used when an anesthesia clinician administers and manages anesthesia for surgical or procedural interventions in the shoulder girdle and axillary region. Its correct application affects billing accuracy, provider reimbursement, and claims adjudication across national payers.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for the code, the typical sites of service where it applies, common related procedure codes, and the range of modifiers that commonly accompany anesthesia claims. The publication also summarizes payer coverage considerations and coding relationships that influence claim processing.
This analysis provides: clear clinical context for CPT code 01610; an overview of associated orthopedic and procedural codes that commonly coexist on the same claim; a list of commonly used anesthesia modifiers and credential taxonomies relevant to billing; and an outline of typical ICD-10 clinical presentations that align with shoulder and knee procedure care paths. The content is intended for national audiences involved in anesthesia billing and policy, including coders, billing managers, and clinical leadership.
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Billing Code Overview
CPT code 01610 describes anesthesia services for procedures involving the nerves, muscles, tendons, fascia, and bursae of the shoulder and axilla. The code covers administration and management of anesthesia provided by an anesthesiologist, certified registered nurse anesthetist, or anesthesiology assistant during surgical or procedural interventions targeted to the shoulder girdle and axillary region.
Service Type: Anesthesia for shoulder and axillary soft-tissue procedures
Typical Site of Service: Operating room or procedure room involving the shoulder and axilla
Clinical & Coding Specifications
Clinical Context
A 62-year-old male with symptomatic right shoulder rotator cuff tendinopathy and bursitis is scheduled for arthroscopic subacromial decompression and rotator cuff repair under monitored general anesthesia with an interscalene nerve block. The patient has a history of controlled hypertension (ASA P2). Preoperative evaluation includes anesthesia assessment, airway exam, medication reconciliation, and informed consent. On the day of surgery the anesthesia team places standard monitors, performs an ultrasound-guided interscalene block for surgical analgesia, induces general anesthesia, manages intraoperative hemodynamics, documents regional block performance and duration, and provides postoperative handoff to PACU staff with pain plan. The procedure involves operative manipulation of the nerves, muscles, tendons, fascia, and bursae of the shoulder and axilla, matching the service described by 01610. Typical sites of service are an ambulatory surgery center or hospital operating room. Expected clinical workflow includes pre-op evaluation, regional block placement, intraoperative anesthesia management, emergence, and postoperative recovery with documentation for billing of the anesthesia service using 01610.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural service | Use when the anesthesia service involved substantially greater work than typical (document rationale and time). |
23 | Unusual anesthesia | Use when anesthesia is delivered for procedures usually performed without anesthesia and documentation supports unusual circumstances. |
50 | Bilateral procedure | Use when identical procedures are performed bilaterally and anesthesia is reported accordingly. |
52 | Reduced services | Use when the anesthesia service provided is partially reduced or incomplete. |
53 | Discontinued procedure | Use when the anesthesia service is discontinued due to patient condition or unforeseen circumstances. |
55 | Postoperative management only | Use when the anesthesiologist provides only postoperative pain management and not intraoperative care. |
62 | Two surgeons | Use when two surgeons work together as primary surgeons during the operative procedure. |
78 | Unplanned return to OR | Use when the patient requires an unplanned return to the operating room for a related procedure during the postoperative period. |
AA | Anesthesia by anesthesiologist | Use to indicate that a physician anesthesiologist personally performed the anesthesia service. |
AD | Medical supervision by anesthesiologist | Use when the anesthesiologist medically directs qualified non-physician anesthesia providers for more than four concurrent cases. |
QK | Medical direction of certified registered nurse anesthetist (CRNA) | Use when the physician medically directs up to four CRNAs and meets CMS direction and supervision requirements. |
QS | Monitored anesthesia care service | Use when monitored anesthesia care (MAC) is provided and billing requires the MAC indicator. |
59 | Distinct procedural service | Use when another procedure or service on the same day is separate and distinct from the anesthesia service (with supporting documentation). |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Anesthesiology | Physician anesthesiologists bill and document anesthesia services including regional and general techniques. |
367500000X | Certified Registered Nurse Anesthetist | CRNAs provide anesthesia services under various supervision models; used when CRNA delivers or co-manages anesthesia. |
207RA0401X | Anesthesiology Assistant | Anesthesiology assistants participate in care under anesthesiologist supervision; taxonomy used for billing and credentialing notes. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M17.11 | Unilateral primary osteoarthritis, right knee | Degenerative joint disease may coexist in patients undergoing shoulder procedures or represent alternate surgical indications in the same patient; relevant for anesthesia risk stratification. |
M17.12 | Unilateral primary osteoarthritis, left knee | Same relevance as M17.11 for laterality and comorbid joint disease affecting perioperative planning. |
S83.241A | Sprain of medial collateral ligament of right knee, initial encounter | Acute ligamentous injury that may require arthroscopic or open repair under anesthesia; included among provided diagnoses for related orthopedic care. |
S83.242A | Sprain of medial collateral ligament of left knee, initial encounter | As above for the left knee; affects perioperative positioning and pain management. |
M23.50 | Chronic instability of knee, unspecified knee | Chronic joint instability may necessitate reconstructive procedures and impacts anesthesia planning and postoperative analgesia. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
29881 | Arthroscopy, shoulder or knee — arthroscopy, knee, surgical; with meniscectomy | May be performed in the same setting for knee procedures; anesthesia 01610 covers regional anesthesia for shoulder/axilla but is conceptually similar for operative joint procedures. |
29880 | Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral) | Related arthroscopic joint procedures that often require intraoperative anesthesia management similar to shoulder procedures. |
27447 | Total knee arthroplasty | Major joint replacement procedure requiring comprehensive anesthesia care; included as a related major orthopedic procedure in perioperative planning. |
20610 | Arthrocentesis, aspiration and/or injection into a joint or bursa | Diagnostic or therapeutic injections performed pre- or postoperatively; anesthesia services may be billed separately if significant anesthesia is provided. |