Neurosurgery Coding Alert

Take the step of checking NCCI before reporting operating microscope

If you're overlooking 69990, you might be passing up over $125 per claim. To know when you can legitimately claim 69990 for operating microscope services, you must determine if your payer follows CPT or CMS guidelines.

CPT Limits When You Can't Bill

For non-Medicare payers that don't follow National Correct Coding Initiative (NCCI) guidelines, you can find instructions for when to report +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]) in a note following the code descriptor in the CPT manual, says Marvel J. Hammer, RN, CPC, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver.

Specifically, CPT instructs that you should not report 69990 with excision of pituitary tumor 61548, diskectomy 63075-63078, internal neurolysis 64727, and sympathectomy procedures 64820-64823.

For all other procedures, you may report 69990 separately if the surgeon uses the operating microscope during the procedure.

For example: The surgeon documents use of the operating microscope during suture of a single digital nerve of the hand (64831, Suture of digital nerve, hand or foot; one nerve). In this case, you can report 69990 in addition to 64831.

Remember: Because 69990 is an add-on code, you do not need to append modifier -51 (Multiple procedures).

CMS Limits When You Can Bill

Medicare payers, or any payer that follows NCCI guidelines, allow you to report 69990 in far fewer circumstances than payers that follow CPT guidelines, says Eric Sandhusen, CHC, CPC, director of compliance for the Columbia University Department of Surgery.

Specifically, the Medicare Carriers Manual, section 15055, allows separate payment for use of 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.

For all other procedures, Medicare considers the operating microscope not payable.

NCCI specifically bundles 69990 to all remaining neurosurgery-specific codes. When reporting for Medicare payers, be sure that you're not reporting 69990 with any musculoskeletal procedures 22210-22830 or nervous system codes 61000-61253, 61548, 61623, 61720-63078, 63600-63702, 63740-64450, 64475 and 64479-64823.

Take the Time to Check

If your surgeon documents in the op note that he used the operating microscope, take the time to cross-check the payer's guidelines to see if you can report the service.

Although this may seem like an unpleasant effort, the National Physician Fee Schedule Database assigns 3.46 relative value units for the physician component of 69990. This works out to about $131, by national Medicare averages.