Otolaryngology Coding Alert

Some otolaryngologists push for billing microscopy, leaving coders to battle the appropriateness of claiming 69990 and 92504. Examining the roles and restrictions of these two codes will tune you in to fraudulent-free reporting. Although Medicare and CPT regulate the use of microscopy codes +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]) and 92504 (Binocular microscopy [separate diagnostic procedure]), many physicians continue to report the codes without heeding national guidelines, says Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Lakewood, N.J. In fact, CMS permits practices to bill 69990 with only about a dozen codes. In addition, because CPT designates binocular microscopy as a "separate procedure," you can report 92504 only when no other procedure is done on that anatomy, Cobuzzi says. With all these rules, you're probably wondering when proper coding permits reporting 69990 and 92504. To determine appropriate billing, you must understand each code's definition. 69990 Describes Microdissection Code 69990 is perhaps one of the most misunderstood procedural codes. Despite its revision in 2002, many otolaryngologists still interpret 69990 as use of an operating microscope based on the code's previous definition (Use of operating microscope [list separately in addition to code for primary procedure]). CPT altered the wording to include "microsurgical techniques, requiring use of operating microscope." The revised definition clarified CPT's intent that physicians report 69990 for procedures involving microsurgery or microdissection rather than as a tool to guide, by magnification or illumination, or otherwise facilitate placements or excisions. Consequently, 69990 does not mean only the use of an operating microscope. "Instead, it is use of microdis-section," Cobuzzi stresses. This technique describes dissecting tissues under a microscope or magnifying glass, according to Stedman's Medical Dictionary. The physician usually teases the tissues apart by means of needles. "For instance, when grafting a free flap the otolaryngologist may anastomose (join) the blood vessels using a microscope to aid the repair," says Seth M. Goldberg, MD, FACS, owner of Aesthetic Facial Surgery of Rockville in Rockville, Md., and assistant clinical professor of otolaryngologyhead and neck surgery at Johns Hopkins University School of Medicine in Baltimore. Know Accepted Primary Surgeries Just because the physician uses microdissection does not mean you should report 69990. CPT allows billing the technique as an add-on service when the primary surgery does not include microdissection 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), CPTconsiders 69990 an inclusive component. So, you may not report [...]