Neurosurgery Coding Alert

Question: An insurance company requested a refund on a payment it made for 69990 when we billed it with 63030. I appealed this request, but the company has denied our appeal and indicated in its denial that CPT states that this code (69990) should not be used -for visualization with magnifying loupes or corrected vision.- Would you explain why it would deny based on this explanation?


Georgia Subscriber

Answer: What the insurance company is trying to explain is that you can't report +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]) when your neurosurgeon uses loupes. Code 69990 represents microsurgical techniques, not just that your physician used magnification to visualize the procedure. Magnifying loupes are different from the surgical microscope.

Solution: You need to look at your neurosurgeon's op report. If the report doesn't specify that he used an operating microscope, or it says he used magnifying loupes, you don't have much chance of winning your appeal. If it does say that he performed microsurgical techniques using the microscope, you have a legitimate reason to question the reason for the denial.

That being said, the National Correct Coding Initiative bundles 69990 into 63030 (Laminotomy [hemilamin-ectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar [including open or endoscopically assisted approach]).

The bundle has a -0- modifier, so you can never unbundle the codes and report them separately. Any payer that follows NCCI edits will deny your claim based on that bundle.