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69990-operating microscope - Did anyone ever get

  1. #1
    Default 69990-operating microscope - Did anyone ever get
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    Did anyone ever get paid on cpt code 69990-add on code with billing cpt code 69631 or 69436 - ?

  2. Default
    Hi Trent! CMS has a list of CPT's that they will allow 69990 to be billed with in their Medicare Claims Processing Munual, Internet-Only Manuals (IOM). The coding guildline in my CPT book says, "CMS bundles code 69990 into all other surgical procedures not on this list, and it should not be reported, even if used. Most edits do not allow modifier use." I have this list, it's long, but the codes you have listed above are not on this list. I'm finding that alot of commercial carriers are following Medicare's policy on this. Sorry!

    Spent this last long weekend in NOLA and had a fab time!

    Jenna, CPC

  3. #3
    thanks jena, hope you went to french quarter
    also the list of codes are in the cpt code at the end of cpt code 69990 are those that the codes can be used or not to use- example 15756-15758, and so on
    Last edited by codedog; 06-02-2010 at 12:31 PM.

  4. Default
    Quote Originally Posted by trent123 View Post
    thanks jena, hope you went to french quarter
    also the list of codes are in the cpt code at the end of cpt code 69990 are those that the codes can be used or not to use- example 15756-15758, and so on
    Hmm, my book doesn't have a list of codes after 69990, so can't answer that. But 15756-15758 is not on the CMS list. Per CMS: 69990 may be paid separately only when submitted with CPT codes - 61304-61546, 61550-61711, 62010-62100, 63081-63308, 63704-63710, 64831, 64834-64836, 64840-64858, 64861-64871, 64885-64891, 64905-64907. And that's it.

    Stayed in the Quarter and ate at all our faves and even brought back Central Market olive salad to make our own muffeletta! Got sunburned, which was fun to show off to everyone here in Seattle.

  5. Default Per CPT book
    "The surgical microscopy is employed when the surgical services are performed using the techniques of microsurgery. Code 69990 should be reported (without modifier 51) in addition to the code for the primary procedure performed. DO NOT use 69990 for visualization with magnifying loupes or corrected vision.
    DO NOT report 69990 in addition to procedures where use of the operating microscope is an inclusive component (15756-15758, 15842, 19364, 19368, 20955-20962, 20969-20973, 22856-22861, 26551-26554, 26556, 31526, 31531, 31536, 31541, 31545, 31546, 31561, 31571, 43116, 43496, 49906, 61548, 63075-63078, 64727, 64820-64823, 65091-68850, 0184T)"

    CMS does bundle 69990 in 69631 and 69436 and not allowed to break out.

  6. Default operating microscope included
    what about in the instance where there is both a 22551 and 63081? my doctor performed a partial corpectomy, discectomy, and arthrodesis. 63081 is not listed as including the microscope, but 22551 includes it. Can it still be reported for the 63081 procedure?

    Partial corpectomy at C5 and C6.
    C4-5, C5-6, and C6-7 diskectomy for decompression.
    C5-6 and C6-7 arthrodesis

  7. #7
    North Carolina
    69990 is allowed with 63081. Many carriers follow CMS' policy...

    F. Operating Microscope

    1. The Internet-Only Manuals (IOM), Medicare Claims Processing Manual, Publication 100-04, Chapter 12, Section 20.4.5 (Allowable Adjustments) limits the reporting of use of an operating microscope (CPT code 69990) to procedures described by CPT codes 61304-61546, 61550-61711, 62010-62100, 63081-63308, 63704-63710, 64831, 64834-64836, 64840-64858, 64861-64870, 64885-64891 and 64905-64907. CPT code 69990 should not be reported with other procedures even if an operating microscope is utilized. CMS guidelines for payment of CPT code 69990 differ from CPT Manual instructions following CPT code 69990. The NCCI bundles CPT code 69990 into all surgical procedures other than those listed in the Medicare Claims Processing Manual. Most edits do not allow use of NCCI-associated modifiers.

    Chapter 8 of the NCCI policy manual

  8. #8
    Default 69990
    Can anyone clarify that 69990 is payable with 63046, i got denial from UHC, stating "According to CPT book, an appropriate modifier along with the medical documents are required to identify procedures/services that are not normally reported together. CPT 69990 unbundles to CPT 63046.Please understand that this is your final level of appeal with us.”

  9. Default 6990
    Can you bill 6990 with 42820?

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