Urology Coding Alert

Question: How would I code a bilateral subinguinal microsurgical varicocelectomy when the urologist used the surgical microscope?

Illinois Subscriber

Answer: You should report CPT 55530 (Excision of varicocele or ligation of spermatic veins for varicocele; [separate procedure]) for the subinguinal varicocelectomy.

Then, use code +69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]) for the use of the operating microscope.

To apply +69990 correctly, however, you'll need to meet three conditions:

1. You should report +69990 only when the surgeon performs a procedure that requires microsurgery or microdissection. For instance, you would not separately report +69990 if the urologist uses the operating microscope only for illumination, or for "visualization with magnifying loupes or corrected vision," according to CPT guidelines.

2. Because +69990 is an add-on code, you should report it only with a related, primary procedure. You would never report +69990 alone. Remember: By definition, an add-on code describes an "additional" service that occurs only at the same time as another, more extensive procedure. You should list this code on your claim immediately following the procedure for which your urologist performed the microsurgery.

3. You may report +69990 as an add-on service only if the primary surgery does not already include possible microdissection or the use of the operating microscope.

Payment cuts averted: When you do apply +69990 appropriately, you should check your explanation of benefits to be sure payers are not applying a multiple-procedure reduction to the code. This is an add-on code, so you do not need to append modifier 51 (Multiple procedures). Forgetting to code for the operating microscope will mean a loss of over $225 per procedure.