CPT 01634: Anesthesia for Open or Arthroscopic Shoulder Procedures
CPT code 01634 represents anesthesia services for open or surgical arthroscopic procedures on the humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint, including shoulder disarticulation. This code identifies perioperative anesthesia care specific to complex shoulder and adjacent-joint surgeries and is used by anesthesiologists and certified registered nurse anesthetists to report services for these operative settings. Nationally, accurate use of this code is important for payment, quality measurement, and resource planning related to upper-extremity surgical care.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks and contextual information on coding relationships and service definitions, clinical context for shoulder and adjacent-joint operative anesthesia, and comparisons to closely related anesthesia codes. The document outlines typical sites of service and the procedural scope covered by the code, and highlights related anesthesia codes to help clarify coding selection in multi-procedure or extended operative scenarios. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 01634 describes anesthesia services provided for patients undergoing open or surgical arthroscopic procedures involving the humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint, and includes procedures up to shoulder disarticulation.
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Service type: Surgical anesthesia for shoulder and adjacent joint procedures
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Typical site of service: Operating room or surgical suite for open or arthroscopic shoulder surgery
Clinical & Coding Specifications
Clinical Context
A 67-year-old patient with progressive right shoulder pain and limited range of motion is scheduled for an open shoulder arthroplasty for advanced glenohumeral osteoarthritis and associated rotator cuff arthropathy. The patient has failed conservative measures including physical therapy, intra-articular injections, and analgesics. Preoperative assessment by the anesthesia team documents coronary artery disease controlled on medication and an ASA physical status of P3. On the day of surgery the anesthesia provider performs general endotracheal anesthesia with interscalene regional block for postoperative analgesia. Intraoperative management includes airway control, invasive blood pressure monitoring per institutional protocol, anesthetic maintenance with volatile agent and short-acting opioid, and regional block catheter placement for postoperative pain control. Postoperatively the patient is transferred to the post-anesthesia care unit (PACU) with handoff to nursing and an acute pain service, and the regional catheter is managed for 48–72 hours as indicated. Documentation includes start and stop times for anesthesia, intraoperative events, regional block consent and technique, and any applicable modifier application (for example 22 for unusually complex anesthesia management if justified).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the anesthesia service required significantly greater work or complexity than usual and documentation supports the increased work. |
23 | Unusual anesthesia | Use when general anesthesia is administered for a procedure that is normally performed with local or no anesthesia due to extenuating circumstances. |
50 | Bilateral procedure | Use when identical surgical procedures are performed on both shoulders during the same operative session. |
52 | Reduced services | Use when the planned anesthesia service is partially reduced or not fully performed. |
53 | Discontinued procedure | Use when anesthesia is provided but the surgical procedure is terminated before completion. |
62 | Two surgeons | Use when two surgeons work together as primary surgeons and anesthesia documentation indicates concurrent surgical teams affecting anesthetic management. |
78 | Unplanned return to operating room (related procedure) | Use when patient returns to the OR for a related procedure during the global period and anesthesia is provided. |
AA | Anesthesia by anesthesiologist | Use to indicate the anesthesiologist personally performed the anesthesia service. |
AD | Medical supervision by anesthesiologist; more than four concurrent anesthesia procedures | Use when the anesthesiologist supervised multiple concurrent CRNAs and billing requires the AD modifier. |
QK | Medical direction of two to four concurrent anesthesia procedures involving qualified services | Use when the anesthesiologist medically directs multiple concurrent anesthetists per CMS rules. |
QS | Monitored anesthesia care (MAC) service | Use when service was MAC rather than general anesthesia and MAC reporting is required. |
QX | CRNA service with CRNA billing (modifiers for CRNA) | Use when a CRNA furnished and billed under applicable rules. |
QY | Anesthesiologist medically directs CRNA | Use when the anesthesiologist medically directs a CRNA per CMS criteria. |
SH | Child under general anesthesia by surgeon | Use only in rare, documented circumstances when the surgeon provides anesthesia for a child and meets payer rules. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Anesthesiology | Physician anesthesiologists who perform and document perioperative anesthesia care for shoulder procedures. |
207LA0401X | Pain Medicine (Anesthesiology) | Anesthesiologists with pain medicine specialization who may perform regional blocks and postoperative pain management. |
367500000X | Certified Registered Nurse Anesthetist | CRNAs who provide or assist with anesthesia delivery; applicable when billing or supervision modifiers (QX,QY,AD) apply. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
M17.10 | Unilateral primary osteoarthritis, unspecified knee | Although a knee osteoarthritis code is listed in the input, this may reflect a comorbid degenerative joint disease; documents overall arthritic disease burden and may affect perioperative management. |
M17.11 | Unilateral primary osteoarthritis, right knee | As above, indicates right knee primary OA as a comorbidity relevant to functional status and rehabilitation planning. |
M17.12 | Unilateral primary osteoarthritis, left knee | As above, indicates left knee primary OA as a comorbidity relevant to functional status and rehabilitation planning. |
M17.5 | Other unilateral secondary osteoarthritis of knee | Denotes secondary osteoarthritis of the knee due to prior trauma or other cause; relevant as coexisting musculoskeletal disease. |
Z96.651 | Presence of right artificial knee joint | Indicates an existing right knee prosthesis; important for perioperative planning (antibiotic prophylaxis considerations, mobility limitations). |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
01636 | Anesthesia for open or surgical arthroscopic procedures on humeral head and neck, sternoclavicular joint, acromioclavicular joint, and shoulder joint; interthoracoscapular (forequarter) amputation | Related code for a more extensive amputation procedure involving the shoulder girdle; used when the surgical procedure performed differs in scope from 01634. |