General Surgery Coding Alert

Question: Can we report 69990 for separate payment if our surgeon uses the operating microscope during an operative session? What are the rules for applying this code?


Nevada Subscriber

Answer: For Medicare payers, a general surgeon shouldn't expect separate reimbursement for +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]). You may have better luck, however, with private payers.

Medicare guidelines allow separate payment for using the operating microscope only with procedures 61304-61546, 61550-61711, 62010-62100, 63081-63308, 63704-63710, 64831, 64834-64836, 64840-64858, 64861-64870, 64885-64898 and 64905-64907. These are generally neurosurgical procedures and therefore not likely performed by a general surgeon.

For all other procedures, Medicare will not pay for the operating microscope. The National Correct Coding Initiative (NCCI) also bundles 69990 extensively.

CPT rules, in contrast, bundle 69990 far less frequently, stating only that you may not report the operating microscope in addition to 15756-15758, 15842, 19364, 19368, 20955-20962, 20969-20973, 26551-26554, 26556, 31526, 31531, 31536, 31541, 31545, 31546, 31561, 31571, 43116, 43496, 49906, 61548, 63075-63078, 64727, 64820-64823 and 65091-68850.

Check with your private payers to determine if they follow CPT or CMS guidelines regarding 69990. If the payer says that it follows CMS guidelines, be sure to get the instructions in writing.

Keep in mind that you should report 69990 only when the surgeon performs a procedure that requires microsurgery or microdissection. You should not claim 69990 if the surgeon uses the microscope only for magnification or illumination.

Finally, you may report 69990 as an add-on service only when the primary surgery does not include microdissection as an integral part of the operation. If the procedure already includes microsurgery, such as grafting a free flap with microvascular anastomosis (15756-15758) or microsurgery (15842), you may not report 69990 in addition, CPT guidelines say.

 -quot; Technical and coding advice for You Be the Coder and Reader Questions provided by Marcella Bucknam, CPC, CCS, CPC-H, CCS-P, charge capture manager for the University of Washington Physicians.