Wiki cpt code 62223 billed with 61781 and 69990 is this payable?

[melanied]

Our Neurosurgeon did a 62223 and used stereotactic navigation 61781 and the microscope is the payable? Medicare says the 61781 is for reporting purposes on the ERA.
Thank you

 

[jrclark1987@yahoo.com]

IT IS PAYABLE. Payers will request operative note to review MN and documentation.

 

[MsAnna]

Our Neurosurgeon did a 62223 and used stereotactic navigation 61781 and the microscope is the payable? Medicare says the 61781 is for reporting purposes on the ERA.
Thank you

My experience is that Medicare has a range of CPT codes that they allow the stealth to be reimbursed with. 62223 is not one of them. Private payers may pay but Medicare doesn't

 

[lexy1011@gmail.com]

I have not been able to find a CMS or MAC article (I've checked IOMs, LCDs, NCDs, even just google) stating which primary codes can be used. Medicare denies this code A LOT, even when following CPT guidelines regarding qualifying codes.
I spoke with Medicare just this morning so they could point me in the right direction and they didn't even have an answer- they instructed me to file a FOIA request in order to get my answer. If I get a resolution in a reasonable timeframe, I will respond again and post the answer. It may be good to file your own request for the same issue as well. This applies to 61781-61783.

 

[RSculthorpe]

I have not been able to find a CMS or MAC article (I've checked IOMs, LCDs, NCDs, even just google) stating which primary codes can be used. Medicare denies this code A LOT, even when following CPT guidelines regarding qualifying codes.
I spoke with Medicare just this morning so they could point me in the right direction and they didn't even have an answer- they instructed me to file a FOIA request in order to get my answer. If I get a resolution in a reasonable timeframe, I will respond again and post the answer. It may be good to file your own request for the same issue as well. This applies to 61781-61783.

Here is what I have for this guideline:
Medicare NCCI 2022 Coding Policy Manual – Chap8CPTCodes -60000-69999 (cms.gov)
8. CPT codes 61781-61783 are Add-on Codes (AOCs) describing computer-assisted navigational procedures of the cranium or spine. CMS payment policy does not allow CPT code 69990 (Microsurgical technique requiring use of operating microscope) to be reported with these codes unless CPT code 69990 is reported with another CPT code that meets the requirements of the Centers of Medicare & Medicaid Services (CMS) “Internet-Only Manual”, Publication 100- 04, “Medicare Claims Processing Manual”, Chapter 12 (Physicians/Nonphysician Practitioners), Section 20.4.5. This “IOM” section limits the separate payment for CPT code 69990 to a small number of procedures. In these situations, providers/suppliers may report modifier 59 or XU with CPT code 69990 to indicate that the procedure described by CPT code 69990 was performed for a procedure other than the computer-assisted navigation on the same date of service.

20.4.5 - Allowable Adjustments (Rev. 1, 10-01-03) B3-15055
Effective January 1, 2000, the replacement code (CPT 69990) for modifier -20 - microsurgical techniques requiring the use of operating microscopes may be paid separately only when submitted with CPT codes: 61304 through 61546
61550 through 61711
62010 through 62100
63081 through 63308
63704 through 63710
64831
64834 through 64836
64840 through 64858
64861 through 64871
64885 through 64891
64905 through 64907.