Wiki 55530 with 69990?

[bharathiT]

"Microscopic subinguinal left varicocelectomy"

* 55530 - Excision of varicocele or ligation of spermatic veins for varicocele;

* 69990 -Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure)

However CPT 69990 is an add on code & we could find CPT varicocelectomy procedure (55530) CPT in primary procedure list for add on 69990.

can we use this add on code (69990) with 55530?



As per NCCI Edit 69990 Inclusive with 55530.

Kindly clarify on this

 

[thomas7331]

The NCCI Manual, Chapter VIII, section F lists the specific procedures for which 69990 may be reported and reimbursed separately. It is a very limited list of spinal and cranial procedures, and 55530 is not included, and NCCI instructs that 69990 should not be reported with any other procedures even if an operating microscope is used.

I'd just note that this guidance contradicts CPT instructions, which do allow for separate reporting. However, for payers that follow NCCI, 69990 will be denied unless you append a modifier, and in this case a modifier would not be appropriate or supported since it would indicate that the use of the microscope was unrelated to the primary procedure that you are billing.