Getting Paid for New CPT Operating Microscope Code
Published on Sun Aug 01, 1999
Although CPT code 69990 (operating microscope) was introduced less than a year ago, questions already are being asked about its proper utilization and how to obtain reimbursement when the microscope is used.
The problems arise mainly because many commercial carriers continue to refuse to pay for microscope use, just as they did before 69990s introduction, when code 61712 (now deleted) was billed for microscope use in spinal and brain surgery, while modifier -20 (also deleted, component) was designated for all other procedures involving the use of the microscope, according to Susan Callaway-Stradley, CPC, CCS-P, senior consultant in the Medical Group at Elliott, Davis and Co., an accounting and consulting firm in Augusta, GA.
There are a lot of issues regarding this code right now because not all carriers recognize it, and many coders are uncertain about usage, she says. Commercial carriers are beginning to take the stance that if the procedure is done with an operating microscope they wont pay for the use of the microscopes, Callaway-Stradley says.
According to Callaway-Stradley, the rationale is as follows: In the old days, not every hospital had a microscope, so the old code was used to credit the extra expense and the expertise required to utilize the microscope. But now, virtually all physicians trained to perform spinal surgery or nerve procedures use an operating microscope.
The same is true for ENT procedures, such as reconstructing the internal ear. You need a scope to perform those procedures effectively, Callaway-Stradley says.
In other words, commercial carriers are saying that since virtually everybody is using the operating microscope and it is an integral part of the procedure in question, they no longer will reimburse it separately.
Many 69990 denials have more to do with this trend and less to do with problems related to the new code itself, Callaway-Stradley says.
Not For Office Procedures
Commercial carriers aside, there are other issues to remember when coding for microscope use. For instance, Medicare, which does reimburse the use of the microscope, will likely deny a procedure performed in the otolaryngologists office using a microscope if it was billed with a 69990, because it is supposed to be an add-on code used during a surgery or procedure. According to CPT 1999, the surgical microscope is employed when the surgical services are performed using the techniques of microsurgery. Code 69990 should be reported (without modifier -51 appended) in addition to the code for the primary procedure code.
Note: HCFA will pay about $180, depending on geographic location, for the 69990, over and above any other procedure.
The correct code for microscope use during an office procedure is 92504 (binocular microscopy [separate diagnostic procedure]), a special otorhinolaryngologic service code.
Callaway-Stradley says it is difficult, though certainly [...]
