Otolaryngology Coding Alert

Medicare ususally won't pay 69990 for ENT surgeries, but others might

Before you assign 69990 every time the surgeon uses the operating microscope, you should first determine whether your payer follows CPT or CMS guidelines.

For non-Medicare payers that don't follow National Correct Coding Initiative 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 any codes that state -with operating microscope- in their descriptor, such as 31526 (Laryngoscopy, direct, with or without tracheostomy; diagnostic, with operating microscope or telescope) and 31545 (Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of non-neoplastic lesion[s] of vocal cord; reconstruction with local tissue flap[s]), among others.

You can find a full list of the codes that CPT instructs coders not to bill with 69990 in the Operating Microscope section of CPT, just above the listing for 69990.

For all other procedures, CPT will allow you to report 69990 separately when the physician performs micro-surgery requiring the microscope. However, 69990 is not supported when the surgeon just uses the operating microscope for visualization. The surgeon must perform a medically necessary microdissection to support reporting 69990.

For example: The otolaryngologist documents his use of the operating microscope and performance of microdissection during a complete mastoidectomy (69502). In this case, you can report 69990 in addition to 69502 for a non-Medicare payer that does not follow NCCI.

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

Be Prepared: Medicare Won't Pay

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 with only a select few codes, none of which apply to ENT practices.

For all other procedures, Medicare considers the operating microscope an inclusive component of the procedure and not payable. According to the July 22, 1999, Federal Register, -In specific, payment for primary codes where an operating microscope is an inclusive component will be denied.-

Limit Yourself to 1 Unit of 69990

You should report only one primary procedure per operative session, which means that no matter how many times you use the operating microscope while in the OR, you can report 69990 only once.

Tip: This rule applies even if the surgeon uses the operating microscope for several procedures during the same session. Therefore, if the surgeon bills three surgical codes on one date, you can still only bill 69990 once--not three times.

Get Payer Guidelines in Writing

If your otolaryngologist documents in the operative  note that he used the operating microscope for microsurgery, cross-check the payer's guidelines to see whether it allows you to report the service with 69990. Some payers can provide you with a list of which codes they-ll allow with 69990.

Documentation tip: Key documentation you may find in the op report can include terms such as -Weck scope,- -Zeiss scope- or -Leica- as well as words such as -microdissection- or -microsurgery.- These words can clue you in to the fact that the surgeon used an operating microscope during surgery.

Although this may seem like an unpleasant effort, most payers will reimburse about $130 for 69990, so researching which private insurers allow you to report it with ENT procedures can be well worth the effort.