Otolaryngology 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.

First, you should report 69990 only when you perform a procedure that requires microsurgery or microdissection. You should not claim 69990 if the surgeon uses the microscope only for magnification or illumination.

Second, because 69990 is an add-on code, you can report it only with another, primary procedure.

Third, CPT allows 69990 as an add-on service only when the primary surgery does not include micro-dissection as an integral part of the operation. If the procedure already includes microsurgery, such as grafting a free flap with microvascular anastomosis (15756-15758) or microsurgery (15842), and direct laryngoscopy using an operating microscope (31526, 31531, 31536, 31541, 31561, 31571), you may not report 69990 in addition, CPT guidelines say.

Private-payer concerns: 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. For private payers that follow CPT (as opposed to CMS) guidelines, these instructions (along with the three requirements outlined above) are the only restrictions you have to consider when reporting 69990.

Medicare differs: Medicare bundles 69990 much more extensively than private payers. For instance, the National Correct Coding Initiative bundles 69990 with ear surgery codes (69501-69554, middle ear excision; 69601-69676, middle ear repair; and 69905-69915, inner ear excision), among many others.

Bottom line: If you-re going to bill Medicare for 69990, be sure to check with NCCI first. Because using the operating microscope could increase your reimbursement by more than $125, you shouldn't assume that Medicare won't pay, but you will find that Medicare will allow separate payment for 69990 in very few instances.

As a final concern, note that 69990 differs from 92504 (Binocular microscopy [separate diagnostic procedure]) in several ways. Most important, the operating microscope is a very large instrument found only in the operating room, whereas 92504 describes a simpler, office-based instrument used only for magnification.