Neurosurgery Coding Alert

Question: Can I report 69990 for using the operating microscope with craniotomy for dural repair (62100)? I know that payers frequently bundle use of the operating microscope. Illinois Subscriber Answer: Yes, you may report +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]) along with 62100 (Craniotomy for repair of dural/cerebrospinal fluid leak, including surgery for rhinorrhea/otorrhea). Both CPT/AMA and CMS/Medicare guidelines allow for this combination. You are correct, however, that payers often bundle 69990 to other same-session procedures during which the surgeon uses the operating microscope. CPT instructs that you should not report 69990 with 61548 (Hypophysectomy or excision of pituitary tumor, transnasal or transseptal approach, nonstereotactic), the anterior cervical and thoracic discectomy codes 63075-63078, internal neurolysis code 64727, or sympathectomy procedures 64820-64823. Also, CPT includes 69990 in 67570 (Optic nerve decompression [e.g., incision or fenestration of optic nerve sheath]).
For all other procedures, you may report 69990 separately if the surgeon documents using the operating microscope for microdissection during the procedure. Medicare and other payers that observe national Correct Coding Initiative guidelines will allow you to report 69990 less often than payers that follow CPT instructions. Specifically, chapter 12 of the Medicare Claims Processing Manual, section 20.4.5, allows separate payment for using the operating microscope only with procedures 61304-61546, 61550-61711, 62010-62100, 63081-63308, 63704-63710, 64831, 64834-64836, 64840-64858, 64861-64870, 64885-64898 and 64905-64907. You may view chapter 12 of the Claims Processing Manual online at http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf. For all other procedures not listed above, 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." In all cases, when reporting 69990, you should assign only one unit per session. -- Technical and coding guidance for You Be the Coder and Reader Questions provided by Gregory Przybylski, MD, director of neurosurgery at the New Jersey uroscience Institute, JFK Medical Center in Edison.