Ophthalmology and Optometry Coding Alert

Question: What are the requirements for reporting the operating microscope (69990)? It seems that everything I hear or see suggests different guidelines.


New York Subscriber
Answer: The reporting requirements for +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]) are indeed tricky, and they've changed a number of times over the years--which only increases the confusion. For ophthalmic surgery, though, the rule for coding separately for the operating microscope is fairly simple: Don't do it.

CPT rules forbid you from reporting 69990 with any of the codes in the "Eye and Ocular Adnexa" section of the CPT manual. "Do not report code 69990 in addition to codes 65091-68850," warns a note at the beginning of that section. Because 69990 is an add-on code, you can report it only with another, primary procedure.

For a complete list of procedures with which the AMA says you should not report an operating microscope, see the parenthetical note following the descriptor for 69990 in the CPT manual. The National Correct Coding Initiative also bundles 69990 into all of the "Eye and Ocular Adnexa" codes, confirming that Medicare considers the operating microscope an intrinsic part of those procedures.

Exceptions: NCCI does not specifically bundle 69990 into the unlisted-procedure codes, or into 65760 (Keratomileusis), 65765 (Keratophakia), 65767 (Epikeratoplasty) or 65771 (Radial keratotomy). Those codes, however, would still fall within the 65091-68850 range.