Otolaryngology Coding Alert

Question: When an assistant surgeon does microdissection and the otolaryngologist performs a complete mastoidectomy, should I bill for the assistant's work? We usually bill private payers for 69990 in addition to complex ear surgeries.

New Jersey Subscriber

Answer: Yes. You may bill for the assistant surgeon's use of the operating microscope with +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]). The Medicare Physician Fee Schedule indicates 69990 qualifies for assistant surgery payment using modifier 80 (Assistant surgeon).

Important: Make sure that the assistant surgeon documents the need for using the microscope. For instance, documentation might state: -The assistant surgeon needed to use microdissection to assist the surgeon to critically remove the bony part during surgery,- or -Used surgical microscope for microdissection of ______________.-

Remember: Although the CPT manual does not list the complete mastoidectomy code (69502, Mastoidectomy; complete) as including 69990, Medicare limits the codes with which you use 69990. The National Correct Coding Initiative bundles microsurgical techniques requiring use of an  operating microscope into ear surgery codes (69501-69554, middle ear excision; 69601-69676, middle ear repair; and 69905-69915, inner ear excision). Because this edit is a budgetary one and does not have a clinical basis for third-party payers that follow CCI, you may report the microsurgery add-on code in addition to complex ear surgery.
 -- Answers to You Be the Coder and Reader Questions answered/reviewed by Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, director of outreach programs for the American Academy of Professional Coders based in Salt Lake City; and Lisa Miller Jones, MS, director of reimbursement for the American Academy of Audiology in Reston, Va.