# microscopic subinguinal varicocelectomy



## Kelly_Mayumi (May 21, 2009)

Has anyone coded a microscopic subinguinal varicocelectomy yet?


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## daniel (Aug 13, 2020)

Kelly_Mayumi said:


> Has anyone coded a microscopic subinguinal varicocelectomy yet?



*Question:* _How would I code a bilateral subinguinal microsurgical varicocelectomy when the urologist used the surgical microscope?_

Illinois Subscriber

*Answer*: You should report *CPT 55530 *(_Excision of varicocele or ligation of spermatic veins for varicocele; [separate procedure]_) for the subinguinal varicocelectomy.

Then, use code +69990 (_Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]_) for the use of the operating microscope.

To apply +69990 correctly, however, you'll need to meet three conditions:


*1. *You should report +69990 only when the surgeon performs a procedure that requires microsurgery or microdissection. For instance, you would not separately report +69990 if the urologist uses the operating microscope only for illumination, or for "visualization with magnifying loupes or corrected vision," according to CPT guidelines.


*2. *Because +69990 is an add-on code, you should report it only with a related, primary procedure. You would never report +69990 alone. Remember: By definition, an add-on code describes an "additional" service that occurs only at the same time as another, more extensive procedure. You should list this code on your claim immediately following the procedure for which your urologist performed the microsurgery.


*3. *You may report +69990 as an add-on service only if the primary surgery does not already include possible microdissection or the use of the operating microscope.

*Payment cuts averted:* When you do apply +69990 appropriately, you should check your explanation of benefits to be sure payers are not applying a multiple-procedure reduction to the code. This is an add-on code, so you do not need to append modifier 51 (_Multiple procedures_). Forgetting to code for the operating microscope will mean a loss of over $225 per procedure.


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## sxcoder1 (Aug 14, 2020)

I never add the 69990 since NCCI edits says it is included.  Do you find you get payment from commercial payers?


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## KaylaRieken (Aug 14, 2020)

I never add it either. Says its included.


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## daniel (Aug 15, 2020)

I quit adding it when I actually noticed cpt 55530 is not primary to 69990


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