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When Is It Appropriate To Bill For An Operating Microscope - CPT 69990?
What is an Operating Microscope?
According the 2012 CPT Book, a surgical operating microscope is used to obtain good visualization of the fine structures in the operating field. The lens system may be operated by hand or foot controls to adjust to working distance, with interchangeable oculars providing magnification as needed. This surgical microscope is used when a provider uses microsurgery techniques. This technique allows providers to operate in very small areas while protecting as much of the surrounding area as possible.
What is an Add-on Code?
Current Procedural Terminology (CPT) 69990 has the symbol "+" next to it - meaning it's an add-on code. Add-on codes are found throughout the various sections of CPT book along with a complete list of all of the add-on codes in Appendix D. As per the introduction of the AMA CPT Book, add-on codes:
- Are listed separately in ADDITION to the primary procedure
- The physician performing the add-on code must be the same one performing the primary procedure
- Add-on codes must never be billed as stand-alone codes
- All add-on codes are exempt from modifier -51
- Can't be used with a code that describes the use of a microscope or microsurgical techniques
When CPT 69990 Can and Can't Be Used?
It is important to note that the CMS guidelines for when CPT 69990 can be billed vary from the AMA Guidelines. [1] In addition, the CMS National Correct Coding Initiative Edits also lists the column1/column2 and mutually exclusive edits for all codes including 69990.[2]
According to the AMA, operating microscopes are not to be used for visualization with magnifying loupes or corrective vision. In addition, the CPT Book lists a number of procedures that include the use of the microscope where CPT 69990 should never be reported separately. [3] The coding guidelines typically tell you when you can't bill 69990 as opposed to when you can. You will need to refer to your respective policies for additional guidance as many payers have their own policies with respect to when 69990 may be billed.
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[1]CMS Manual
[2]CCI Edits
[3]AMA CPT 2012 - CPT Codes that include 69990: 15756-15758, 15842, 19364, 19368, 20955-20962,20969-20973, 22551, 22552, 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, 0226T, 0227T |
