Otolaryngology Coding Alert

Question: Can we report 69990 if the surgeon uses the operating microscope during a tube change (69436)?


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Answer: No, you should not report +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]) if the surgeon uses the microscope for visualization only. You should claim 69990 only when the surgeon performs a procedure that requires microsurgery or microdissection. Microsurgery techniques are not required for 69436 (Tympanostomy [requiring insertion of ventilating tube], general anesthesia).

The add-on code 69990 has more relative value units than the -primary- procedure 69436 (3.46 work RVUs vs. 1.96 work RVUs). This should provide a clue that 69990 represents an extensive additional service and not simply a convenient way to visualize the operative field.
 
Learn more: See -Report 69990 With Caution- on page 95 of the December 2005 Otolaryngology Coding Alert. Clinical and coding expertise for You Be the Coder and Reader Questions provided by Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Shrewsbury, N.J.; and Charles F. Koopmann Jr., MD, MHSA, professor and associate chair at the University of Michigan's department of otolaryngology in Ann Arbor.