Otolaryngology Coding Alert

Question: When my ENT uses a microscope during a procedure, what guidelines can I use for choosing between 92504 and +69990? Is there a rule governing how many times you can report the add-on code 69990?

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Answer: You can use 92504 (Binocular microscopy [separate diagnostic procedure]) when your ENT is just looking through the microscope to assist in a procedure, usually in the office. However, +69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]) is only for microdissection and involves a large operating microscope usually found hanging from the ceiling in the operating room. So, if the operating microscope is being used to place a tube in a myringotomy incision, your ENT doesn't meet the definition for +69990. To claim +69990, the procedure note must demonstrate that your ENT performed microsurgery and did more than just look through the microscope lens.

Example: Your ENT placing a tube in the ear (such as 69436, Tympanostomy [requiring insertion of ventilating tube], general anesthesia) doesn't require microdissection, so you won't code +69990.

Just 1 unit: You should report only one primary procedure per operative session, which means that no matter how many times you use the operating microscope and perform microdissections while in the OR, you can report +69990 only once. Also, you should report only a single unit of +69990, even if the ENT uses both a telescope and an operating microscope during the same session. CPT guidelines preceding endoscopy codes 31505-31579 clearly indicate, "If using operating microscope, telescope, or both, use the applicable code only once per operative session."

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

Payment cuts averted: When you do apply +69990 appropriately, you should check your explanation of benefits to be sure payers don't apply a multiple-procedure reduction to the code.

All payers are not equal when it comes to reimbursing for +69990. For Medicare payers, an ENT shouldn't expect separate reimbursement with ear procedures when she performs microdissection, as Correct Coding Initiative (CCI) edits bundle it in. You may have better luck with some private payers.