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69990 with 63030

  1. Question 69990 with 63030
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    I am confused, I have many tools to utilize for research the above - per AMA CPT Professional 2011 the above codes are allowed together, as the list under 69990 does not include 63030 as a procedure that includes 69990 as an inclusive component. When I search NCCI Column 1/Column 2 Edits it is showing 69990 is not allowed and modifier not permitted as well.

    Per the AMA CPT Network site - 69990 states all the codes listed within the AMA CPT Manual under the italic portion are considered to have the operating microscope as an inclusive component. If all is correct, then why is CCI saying "NEVER RULE" applies and considers 69990 inclusive to 63030?

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    Quote Originally Posted by scar5901 View Post
    I am confused, I have many tools to utilize for research the above - per AMA CPT Professional 2011 the above codes are allowed together, as the list under 69990 does not include 63030 as a procedure that includes 69990 as an inclusive component. When I search NCCI Column 1/Column 2 Edits it is showing 69990 is not allowed and modifier not permitted as well.

    Per the AMA CPT Network site - 69990 states all the codes listed within the AMA CPT Manual under the italic portion are considered to have the operating microscope as an inclusive component. If all is correct, then why is CCI saying "NEVER RULE" applies and considers 69990 inclusive to 63030?
    CMS does allow 69990 with some codes but very few...

    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"

    Many (if not all) of my commerical carriers follow the same guideline. You could appeal, but it is still often denied.

    You can find the following guidance in chapter 8 of the NCCI policy manual

    http://www.cms.gov/NationalCorrectCo....asp#TopOfPage

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