Surgery Coding Challenge: Master Microsurgery Units With This Advice

Posted on 28. Jan, 2010 by Editor in Coding Challenge

Check your EOB to make sure payers don’t apply a multiple-procedure reduction to +69990.

Question: When my ENT uses a microscope during a procedure, what guidelines can I use for choosing between 92504 and +69990? Is there a rule governing how many times you can report the add-on code 69990?

Answer…
You can use 92504 (Binocular microscopy [separate diagnostic procedure]) when your ENT is just looking through the microscope to assist in a procedure, usually in the office.

Code +69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]), however, is only for microdissection and involves a large operating microscope usually found hanging from the ceiling in the operating room. So, if the operating microscope is being used to place a tube in a myringotomy incision, your ENT doesn’t meet the definition for +69990. To claim +69990, the procedure note must demonstrate that your ENT performed microsurgery and did more than just look through the microscope lens.

Example: When your ENT places a tube in the ear, that doesn’t require microdissection, so you won’t code +69990.

Just 1 unit: You should report only one primary procedure per operative session, which means that no matter how many times you use the operating microscope and perform microdissections while in the OR, you can report +69990 only once. Also, you should report only a single unit of +69990, even if the ENT uses both a telescope and an operating microscope during the same session. CPT guidelines preceding endoscopy codes 31505-31579 clearly indicate, “If using operating microscope, telescope, or both, use the applicable code only once per operative session.”

Tip: This rule applies even if the surgeon uses the operating microscope and performs microdissection within several procedures during the same session. Therefore, if the surgeon bills...

Tags: 69990, 92504, add-on, CCI, ENT, EOB, microscope, microsurgery, surgery