Wiki Question about microscope billing

[bettze1947]

If the op report states the Dr used a loupe w/magnification, does this indicate use of a microscope? What procedures would always require the use of the microscope? Would the use of the microscope have to be documented in the op note in order for the microscope code to be added?

 

[RebeccaWoodward*]

If the op report states the Dr used a loupe w/magnification, does this indicate use of a microscope? What procedures would always require the use of the microscope? Would the use of the microscope have to be documented in the op note in order for the microscope code to be added?

That is correct. Medicare has designated a range of codes specifically billable with 69990.

61304-61546, 61550-61711, 62010-62100, 63081-63308, 63704-63710, 64831, 64834-64836, 64840-64858, 64861-64870, 64885-64891 and 64905-64907.

Now...Commerical carriers may pay for 69990 with other procedures. Those denied could be won on appeal.

The use of the microscope does need to be documented in the op note in order to be paid. It's also important to have it documented in the event you need to conduct an appeal and prove medical necessity.

http://www.cms.hhs.gov/NationalCorrectCodInitEd/01_overview.asp#TopOfPage

NCCI Policy Manual-Chpt 8-Page 11

 

[SS62]

FYI
When I checked the code, it is an ASC approved procedure, however Medicare will NOT pay for it...

 

[rkmcoder]

Look at 69990

Please look at add-on code 69990 in your CPT book. Also, go to this link:

http://www.codinginstitute.com/articles/Withstand_Microsurgical_Techniques.html

As usual, be wary of what is found on the internet.

 

[RebeccaWoodward*]

FYI
When I checked the code, it is an ASC approved procedure, however Medicare will NOT pay for it...

Medicare does have a policy on which codes are payable.

 

[SS62]

69990 has an NI indicator: Not payable in ASC and considered inclusive. This is located on Medicares website under ASC Payment.

 

[RebeccaWoodward*]

Ahhhh...My apologies. Completely overlooked your statement regarding ASC.

 

[SS62]

its okay, for a minute there, i thought maybe i was losing income..LOL

 

[FTessaBartels]

Operating Microscope is NOT Loupe Magnification

If the op report states the Dr used a loupe w/magnification, does this indicate use of a microscope? What procedures would always require the use of the microscope? Would the use of the microscope have to be documented in the op note in order for the microscope code to be added?

Please see the guidelines for CPT 69990 (pg 341 in 2010 Professional Edition CPT), which read, in part: Do not use 69990 for visualization with magnifying loupes or corrected vision. (emphasis added by FTB)

F Tessa Bartels, CPC, CEMC

 

[RebeccaWoodward*]

Tessa,

You are so right and I stand corrected. 69990 is not intended to describe using the microscope for illumination or magnification alone but rather for the work of microdissection. Big oversight on my part for not mentioning this.