Summary & Overview
CPT 01758: Anesthesia for Elbow Surgery, Excision of Cyst or Tumor
CPT code 01758 represents anesthesia services for open or surgical arthroscopic procedures of the elbow, specifically for the excision of a cyst or tumor of the humerus. This code is significant for anesthesiology practices nationwide, as it addresses complex surgical cases requiring specialized anesthesia care. The publication covers major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, providing a comprehensive overview of payer coverage and policy considerations for this procedure.
Readers will gain insights into clinical benchmarks, policy updates, and billing practices relevant to anesthesia for elbow surgeries. The summary includes information on typical sites of service, common modifiers, and associated clinical diagnoses, offering context for accurate coding and reimbursement. Additionally, related CPT codes for similar procedures are highlighted, helping providers understand the scope of anesthesia services for upper extremity surgeries. This resource is designed to inform healthcare professionals, billing specialists, and policy analysts about the key aspects of CPT code 01758 and its role in surgical anesthesia care.
CPT Code Overview
CPT code 01758 is used to report anesthesia services for open or surgical arthroscopic procedures of the elbow, specifically for the excision of a cyst or tumor of the humerus. This code falls under the anesthesiology service type and is typically performed in the operating room setting, most commonly designated as place of service 21. The procedure involves providing anesthesia care to patients undergoing complex surgical interventions on the elbow and humerus, ensuring patient safety and comfort during the excision of abnormal growths.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting with persistent pain or swelling in the elbow, often due to a cyst or tumor located in the humerus. After diagnostic imaging and clinical evaluation, the patient is scheduled for an open or surgical arthroscopic excision of the cyst or tumor. The procedure is performed in the operating room, and anesthesia services are provided throughout the surgery to ensure patient comfort and safety. The anesthesiology team manages the patient's airway, monitors vital signs, and administers appropriate anesthetic agents during the excision procedure.
Coding Specifications
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Modifiers:
QS: Monitored anesthesia care service. Used when the anesthesia provider is present and monitoring the patient, but not providing general anesthesia.QX: CRNA service with medical direction by a physician. Used when a Certified Registered Nurse Anesthetist (CRNA) is providing anesthesia care under the medical direction of a physician.
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Provider Taxonomies:
207P00000X: Anesthesiology. Represents providers specializing in the administration of anesthesia and perioperative care.
| Modifier Code | Description |
|---|---|
| QS | Monitored anesthesia care service |
| QX | CRNA service with medical direction by a physician |
| Taxonomy Code | Specialty |
|---|---|
| 207P00000X | Anesthesiology |
Related Diagnoses
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M25.521: Pain in right elbow- Indicates the patient is experiencing pain localized to the right elbow, which may prompt evaluation for underlying cysts or tumors.
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M25.522: Pain in left elbow- Indicates pain in the left elbow, relevant for patients undergoing excision procedures on that side.
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M75.121: Incomplete rotator cuff tear or rupture of right shoulder, not specified as traumatic- While primarily a shoulder diagnosis, it may be considered in differential diagnosis or when evaluating upper extremity pain.
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M75.122: Incomplete rotator cuff tear or rupture of left shoulder, not specified as traumatic- Similar to
M75.121, relevant for upper extremity pain assessment.
- Similar to
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M77.11: Lateral epicondylitis, right elbow- Commonly known as tennis elbow, this condition can cause pain and may be associated with cysts or tumors requiring surgical intervention.
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M77.12: Lateral epicondylitis, left elbow- Similar to
M77.11, affecting the left elbow and potentially leading to surgical procedures for excision.
- Similar to
Related CPT Codes
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01742: Anesthesia for open or surgical arthroscopic procedures of the elbow; osteotomy of humerus- Used when the surgical procedure involves cutting and realigning the humerus bone. This code is related to
01758as both are anesthesia services for elbow procedures, but for different surgical interventions.
- Used when the surgical procedure involves cutting and realigning the humerus bone. This code is related to
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01744: Anesthesia for open or surgical arthroscopic procedures of the elbow; repair of nonunion or malunion of humerus (Includes repair of humeral shaft fractures)- Used when the procedure addresses healing issues or deformities in the humerus. This code is related to
01758as an alternative anesthesia service for other complex elbow surgeries.
- Used when the procedure addresses healing issues or deformities in the humerus. This code is related to
These codes are alternatives to 01758 and are selected based on the specific surgical procedure performed. They are not typically used together but may be considered in similar clinical workflows for elbow surgery.
National Reimbursement Benchmarks
National mean rates for CPT code 01758 show that Blue Cross Blue Shield and Cigna reimburse at higher levels compared to BUCA (average commercial), with Cigna leading at $299.27 and BUCA at $135.60. UnitedHealth Group has the lowest mean rate among commercial payers at $65.58. Medicare rates are not available in the input for comparison.
Rate dispersion varies significantly across payers. Cigna exhibits the widest spread, with a difference of $344.00 between its 75th and 25th percentiles, indicating substantial variability in reimbursement. UnitedHealth Group has the tightest range, with only $25.35 separating its 75th and 25th percentiles, suggesting more consistent rates. The table and chart below present the full breakdown of national benchmarks for each payer.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska demonstrates a significant spread in reimbursement rates for CPT code 01758, particularly with Blue Cross Blue Shield, where the difference between the 75th and 25th percentiles is $96.73. In contrast, Aetna, Cigna, and UnitedHealth Group show minimal rate variation, each with a spread of only $3.00. This indicates that Blue Cross Blue Shield's rates are not only higher but also more variable compared to other payers in the state.
Compared to national averages, most Alaska payers offer higher mean rates, especially Blue Cross Blue Shield, which exceeds its national mean by over $80. The table and chart below present the full breakdown of payer-specific rates for Alaska, highlighting the differences in reimbursement across the major commercial payers.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT code 01758 in Alaska, with a mean rate of $328.09.
- UnitedHealth Group offers the lowest mean rate in Alaska at $74.78.
- Mean rates for most payers in Alaska are higher than their respective national averages, except for Cigna and UnitedHealth Group, which are below national benchmarks.
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