General Surgery Coding Alert

Question: May I report 69990 separately with 35301 for carotid endarterectomy? Indiana Subscriber Answer: Yes, you may report +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]) in addition to 35301 (Thromboendarterectomy, with or without patch graft; carotid, vertebral, subclavian, by neck incision) if the surgeon uses a surgical microscope (as opposed to magnifying optical loupes) during the operation. The code combination is unusual, however, so be sure to indicate the reason the physician used the microscope in the operative note and don't be surprised if the payer initially rejects 69990. Payment guidelines for the operating microscope are strict and getting more so as time passes. CPT includes a list of codes for which 69990 is an integral component and therefore not separately reportable (see text accompanying the code descriptor). CMS, however, has developed a much more restrictive list (all are 60000-series codes: for a complete list, go to http://www.gamedicare.com/NewsPubs/mar00/mar00p6.htm and scroll to the bottom of the page), and many payers have adopted these guidelines. When in doubt about the applicability of 69990, ask your payer. Technical and coding advice for You Be the Coder and Reader Questions provided by Marcella Bucknam, CPC, CCS-P, CPC-H, CCA, HIM Program Coordinator at Clarkson College in Omaha, Neb.