Otolaryngology Coding Alert

Medicare will not pay when CPT code 69990 (use of operating microscope [list separately in addition to code for primary procedure]) is used, according to a Federal Register entry dated July 22, 1999.

Otolaryngology Coding Alert has received more than a dozen inquiries about the use of this code, which some medical equipment salespeople claim is reimbursable. Otolaryngologists have been told that by adding this code to the primary procedure, the microscope will pay for itself. That is not the case.

According to the Federal Register entry, the primary procedure codes for which we would pay separately for code 69990 are 61304 through 61711, 62010 through 62100, 63081 through 63308, 63704 through 63710, 64831, 64834 through 64907. None of these codes are codes typically used by otolaryngologists.

The rationale for not paying for the microscope, says Susan Callaway-Stradley, CPC, CCS-P, an independent coding and reimbursement specialist in North Augusta, SC, is that it constitutes an integral part of some procedures, such as reconstructing the internal ear, and as such is already built into that procedure. Conversely, the microscope may be utilized by the otolaryngologist when simpler equipment might be just as effective, she says.

In any event, 69990 is a surgical microscope and should not be coded for a procedure using a microscope in the physicians office. Instead code 92504 (binocular microscopy [separate diagnostic procedure]) should
be used.

That code, too, may be difficult to get payment for, Callaway-Stradley says, because as a separate procedure, it should only be billed if it is the only procedure performed on that day.

If the otolaryngologist uses the microscope during an office visit and then performs a procedure, 92504 will not be reimbursed, unless the physician uses it for a purpose unrelated to the primary procedure. For example, if the physician is performing a procedure on the patients left ear, and uses the microscope to examine the patients right ear, use of the scope could be billed 92504-59. The -59 modifier (distinct procedural service) is used when procedures are performed at different locations or at different times during the same day. In this scenario, modifier -52 (reduced services) might also need to be appended to the 92504.

The bottom line is: Dont be swayed by medical equipment salespeople. Do your reimbursement research before you purchase the microscope.

Text of Federal Register Entry, July 22, 1999, page 39629 Use of Operating Microscope (CPT Code 69990) CPT code 69990 replaced two previous codes, 61712 and 64830. These previous codes were add-on codes that could be used only with certain primary procedure codes. The RUC evaluated the work RVUs for code 69990 as a budget-neutral, weighted average of the RVUs for codes 61712 and 64830. However, code 69990 also replaces the use of a -20 microsurgery modifier. The CPT modifier -20 could be used with a wide range of primary procedure codes, but we have not paid additional amounts when the CPT modifier -20 is submitted. No evidence was presented at the RUC that the work has changed for those procedures formerly qualified by the CPT microsurgery modifier -20 and now associated with the code 69990. Therefore, we would pay separately for code 69990 only if it is submitted as an add-on code to a primary procedure for which the use of code 61712 or 64830 was acceptable. The primary procedure codes for which we would pay separately for code 69990 are 61304 through 61711, 62010 through 62100, 63081 through 63308, 63704 through 63710, 64831, 64834 through 64836, 64840 through 64858, 64861 through 64870, 64885 through 64898, and 64905 through 64907 (nervous system).