Neurosurgery Coding Alert

Question: In our practice, we have always thought that 69990 could be billed with procedures that are not specifically excluded in the code descriptor or elsewhere in CPT. Is it appropriate to report 69990 to non-Medicare payers for lumbar codes such as 63030, 63042, 63047, 63267, etc.? 

Colorado Subscriber

 
Answer: Some private payers are likely to follow Medicare's lead and allow 69990 (use of operating microscope [list separately in addition to code for primary procedure]) only in addition to the services covered under the codes it replaced, 61712 and 64830. CPT lists only the procedures 69990 cannot be billed with, but the Centers for Medicare & Medicaid Services (CMS, formally HCFA) published a much more restrictive list of codes with which 69990 can be reimbursed. These include 61304, 61711, 62010, 62100, 63081, 63308, 63704, 63710, 64831, 64834, 64836, 64840, 64858, 64861, 64870, 64885, 64898, 64905 and 64907.
 
However, many payers follow CPT guidelines. Check with your carrier to determine its policy. It is also essential that the operative report specifically indicate the use of the microscope. When billing 69990, remember that it is an add-on code and payment should not be reduced.