Summary & Overview
CPT 01120: Anesthesia for Procedures on Bony Pelvis
CPT code 01120 covers anesthesia services for procedures on the bony pelvis, a critical component in surgical care for patients with pelvic fractures, neoplastic disease, or other complex conditions affecting the pelvic region. This code is nationally recognized and plays a vital role in ensuring appropriate reimbursement and clinical documentation for anesthesiology services in inpatient hospital settings. The publication provides an in-depth overview of the clinical context, including typical diagnoses such as fractures and osteoporosis-related complications, and highlights the importance of accurate coding for both compliance and quality reporting.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, reflecting broad national coverage and relevance for providers and health systems. Readers will gain insights into current policy updates, coding benchmarks, and the clinical scenarios where CPT code 01120 is most commonly applied. The summary also addresses related codes and modifiers, offering a comprehensive perspective on billing practices and payer requirements for anesthesia services in pelvic procedures. This information is essential for understanding the evolving landscape of anesthesiology billing and its impact on patient care and hospital operations.
CPT Code Overview
CPT code 01120 is designated for anesthesia services provided during procedures on the bony pelvis. This code is utilized by professionals in the field of anesthesiology to ensure patient comfort and safety during complex surgical interventions involving the pelvic bones. The typical site of service for procedures billed under CPT code 01120 is the inpatient hospital setting, specifically at Place of Service 21. This reflects the nature of pelvic surgeries, which often require comprehensive perioperative care and monitoring.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult admitted to an inpatient hospital for surgical intervention on the bony pelvis. The patient may present with a fracture of the pelvis, coccyx, or lumbar spine, or with a pathological fracture due to neoplastic disease or osteoporosis. The anesthesiology team provides anesthesia services for the procedure, ensuring patient safety and comfort during surgical repair or management of the pelvic bone condition. The workflow includes preoperative assessment, administration of anesthesia, intraoperative monitoring, and postoperative care in the hospital setting.
Coding Specifications
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Modifiers:
QS: Monitored anesthesia care service. Used when the anesthesia provider delivers monitored anesthesia care rather than general anesthesia.QX: CRNA service with medical direction by a physician. Used when a Certified Registered Nurse Anesthetist (CRNA) provides anesthesia under the medical direction of a physician.
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207L00000X | Anesthesiology |
367H00000X | Anesthesiologist Assistant |
367500000X | Certified Registered Nurse Anesthetist |
These taxonomies represent the specialties eligible to provide anesthesia services for procedures on the bony pelvis.
Related Diagnoses
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S32.9XXA: Fracture of unspecified part of lumbar spine and pelvis, initial encounter- Relevant for patients undergoing anesthesia for surgical repair of pelvic or lumbar spine fractures.
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M84.459A: Pathological fracture in neoplastic disease, pelvis, initial encounter- Indicates a fracture of the pelvis due to underlying neoplastic disease, requiring anesthesia for surgical management.
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M87.051: Idiopathic aseptic necrosis of pelvis- Represents necrosis of pelvic bone, which may necessitate surgical intervention and anesthesia.
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M80.059A: Age-related osteoporosis with current pathological fracture, pelvis, initial encounter- Used when a patient with osteoporosis sustains a pathological fracture of the pelvis, requiring anesthesia for treatment.
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S32.2XXA: Fracture of coccyx, initial encounter- Pertains to patients with a coccyx fracture needing anesthesia for surgical repair or management.
Related CPT Codes
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01112: Anesthesia for procedures on the pelvis (except hip) – bone marrow aspiration or biopsy of iliac crest. This code is used when anesthesia is provided for bone marrow procedures involving the iliac crest, which is part of the pelvis. It is related to01120as both involve anesthesia for pelvic procedures, but01112is specific to bone marrow aspiration or biopsy. -
01130: Anesthesia for procedures on the pelvis (except hip) – body cast application or revision. This code applies when anesthesia is required for the application or revision of a body cast involving the pelvis. It is related to01120as both pertain to pelvic procedures, but01130is specific to cast management.
These codes may be used as alternatives to 01120 depending on the specific pelvic procedure performed. They are not typically used together but may be selected based on the clinical scenario.
National Reimbursement Benchmarks
Nationally, the mean rate for CPT code 01120 among commercial payers (BUCA) is $176.40, while UnitedHealth Group (UHC) has a notably lower mean rate at $65.60. Blue Cross Blue Shield (BCBS), Cigna, and Aetna all report higher mean rates, with Cigna at $350.90, BCBS at $322.24, and Aetna at $253.61.
Rate dispersion varies significantly across payers. BCBS shows the tightest range between the 25th and 75th percentiles ($194.50), indicating more consistent reimbursement levels. Cigna exhibits the widest dispersion ($430.50), suggesting greater variability in rates. Aetna and BUCA also display substantial ranges, while UHC's rates are relatively close together ($25.33).
The table and chart below present a detailed breakdown of national mean rates and percentile values for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska exhibits a wide spread in reimbursement rates for CPT code 01120, with Blue Cross Blue Shield showing the largest range between the 25th and 75th percentiles ($536.00 minus $323.20 = $212.80). In contrast, Aetna, Cigna, and UnitedHealth Group display minimal rate variation, with their 25th, 50th, and 75th percentiles clustered closely together. This indicates that Blue Cross Blue Shield and BUCA have more variability in provider payments, while the other payers maintain consistent rates across providers.
Compared to national averages, Alaska's mean rates for most payers are notably higher, especially for Blue Cross Blue Shield and BUCA. The table and chart below present the full breakdown of payer-specific rates, highlighting the substantial differences in reimbursement across payers within the state.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 01120 in Alaska, with a mean rate of $416.05.
- UnitedHealth Group offers the lowest mean rate at $75.12.
- Mean rates for most payers in Alaska are significantly higher than their respective national averages, especially for Blue Cross Blue Shield and BUCA.
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