Neurosurgery Coding Alert

Question: Every time we report 69990, the carrier denies the claim, and each succeeding version of CCI includes more edits disallowing separate reimbursement for the operating microscope. Exactly when can I report 69990 separately?

Delaware Subscriber

Answer: As standards of care evolve and use of the operating microscope becomes more common, the national Correct Coding Initiative (CCI) seems to bundle +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]) to more codes than the previous version. And providers face even more frustration because payers don't follow a consistent policy regarding the code.

CPT includes a list of codes with which you should not report 69990 in the text preceding the code. If your payer follows CCI, you must check your coding against those edits as well.

CMS meanwhile has simplified (and severely restricted) billing by printing a short list of codes with which you can report 69990. These include 61304, 61711, 62010, 62100, 63081, 63308, 63704, 63710, 64831, 64834, 64836, 64840, 64858, 64861, 64870, 64885, 64898, 64905 and 64907.

The best way to know when to report 69990 is to ask your individual insurers for their guidelines. In any event, you must specifically indicate in the operative report that the surgeon employed the microscope (rather than simple loupes). When reporting 69990, remember that it is an add-on code for which modifier -51 (Multiple procedures) is not necessary and for which the payer should not reduce reimbursement.

Clinical and coding expertise for You Be the Coder and Reader Questions provided by Eric Sandham, CPC, compliance manager for Central California Faculty Medical Group, a group practice and training facility associated with the University of California at San Francisco in Fresno.