CPT® defines certain operative procedures as including the use of an operating microscope, code 69990.
69990 is an add on code, indicated by the plus sign in front of it in the CPT® book. It is billed as a second procedure, without modifier 51. At the start of the section about this code there is a list of CPT® codes which include already the operating micrsocope. If the service being performed is on that list, do not report 69990 in addition to it.
In 2009, 69990 had total RVUs of 5.81.
It won't surpise anyone to know that has a different set of rules regarding 69990. Below, are citations from the Claims Processing Manual and the NCCI edits. Source documentation is listed under citations.
CMS only allows payment of the operating microscope with these codes:
20.4.5 - Allowable Adjustments
(Rev. 1, 10-01-03)
Effective January 1, 2000, the replacement code (CPT® 69990) for modifier -20 -
microsurgical techniques requiring the use of operating microscopes may be paid
separately only when submitted with CPT® codes:
61304 through 61546
61550 through 61711
62010 through 62100
63081 through 63308
63704 through 63710
64834 through 64836
64840 through 64858
64861 through 64871
64885 through 64891
64905 through 64907.
Here's what they say in the NCCI manual, Chapter 1 about 69990:
1. Three or more HCPCS/CPT® codes may be reported on the same date of service. Although the column two code is misused if reported as a service associated with the column one code, the column two code may be appropriately reported with a third HCPCS/CPT® code reported on the same date of service. For example, CMS limits separate payment for use of the operating microscope for microsurgical techniques (CPT® code 69990) to a group of procedures listed in the online Claims Processing Manual (Chapter 12, Section 20.4.5 (Allowable Adjustments)). The NCCI has edits with column one codes of surgical procedures not listed in this section of the manual and column two CPT® code of 69990. Some of these edits allow use of NCCI-associated modifiers because the two services listed in the edit may be performed at the same patient encounter as a third procedure for which CPT® code 69990 is separately reportable.
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
Your practice has utilized the same medical billing software for years. The medical billing staff says it is time for a change. You don't necessarily disagree, but you also don't know where to begin your search for new software. There are so many vendors offering so many products that making sense of it all can be challenging.
Each year CMS publishes an Advance Notice of the upcoming years Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies and asks for comments related to it. Each of the comments are carefully reviewed and responded to and often are impactful to changes seen between the Advance Notice and final publication referred to as the Rate Announcement. With health equity as a primary focus for 2023, CMS announced some policy changes that may impact your organization.
Medicare Advantage Organizations (MAOs) have gone back and forth on whether or not to use data collected from telehealth, virtual Care, and telephone (audio-only) encounters with Medicare beneficiaries for risk adjustment reporting, but the following published documents from CMS cleared that up once and for all by providing an answer to a question specifically related to this question.
We’ve seen a number of OIG risk adjustment data validation (RADV) audits recently where the independent review contractor was simply looking for any codes the payer reported that were not supported by the documentation, in an effort to declare an overpayment was made and monies are due to be repaid. However, it was refreshing to read this RADV audit and discover that the independent review contractor actually identified HCCs the payer failed to report that, while still resulting in an overpayment, was able to reduce the overpayment by giving credit for these additional HCCs. What lessons are you learning from reading these RADV audit reports?
After events of mass violence, it’s easy to feel helpless, like there is little we can do. In fact, we can help individuals, families, and communities build resilience and connect with others to cope together. The SAMHSA-funded National Child Traumatic Stress Network has developed a range of resources to help children, families, educators, and communities including the following which you can access via links in this article.
HIPAA covers nearly every aspect of how medical and personal information is collected, utilized, shared, and stored within the healthcare industry. Title II of the rules is applied directly to medical billing companies and independent coders. The 'Big 2' rules that medical billing companies must adhere to revolve around privacy and security.
It appears that the end of the 1135 waivers related to the COVID-19 public health emergency (PHE) has begun. According to CMS, the residents of skilled nursing facilities, long-term care facilities, and inpatient hospice centers have struggled due to the effects of some of the 1135 waivers. CMS is focusing primarily on removing the 1135 blanket waivers that pertain to certain aspects of care, training, and maintenance of these facilities to ensure the weakest of our citizens are guaranteed adequate care.