Have you ever faced denials for microsurgery insurance claims? You likely used the wrong add-on codes. CPT code 69990 is a frequently used add-on code for microsurgical procedures. It is particularly vital for neurosurgeries. Why? It is employed in complex neurosurgeries that have high reimbursement rates. One denial can significantly harm your revenue.
That’s why we have created this detailed guide on CPT code 69990. We hope that with the help of this guide, you will reduce your denial rates and improve your revenue. So, let’s start.
CPT Code 69990 – Description
CPT code 69990 is defined as:
“Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure).”
Code 69990 is a surgical code that is used when the surgeon uses an operating microscope during the surgery to aid in microsurgical techniques. Additionally, as evident from the definition, 69990 is an add-on code. It is billed with a “+” symbol. It must not be billed separately and should be appended to a primary code.
What many medical billers misunderstand about this code is that it can be used when magnifying loupes, corrective lenses, or other simple magnification devices are used. However, this is a misconception. CPT code 69990 can only be applied when sophisticated operating microscopes are used.
The code includes reimbursement for every service related to the microscope, such as setting up, calibrating, positioning, and adjusting the operating microscope when brought into the surgical field.
Scenarios Where CPT Code 69990 is Applicable
Still confused about meeting requirements? Here are a couple of scenarios to help you understand CPT code 69990 better:
Excision of Craniopharyngioma
Suppose a 45-year-old man visits a neurologist. He complains of persistent headaches, blurred vision in both eyes, and unexplained weight gain. He also shares that he has been feeling more fatigued than usual. After learning all this, the physician prescribes some medicines. The patient tries the medications for 15 days, but does not feel better. So, he again visits the neurologist, and this time the physician orders a head scan. The results are shocking and reveal a craniopharyngioma compressing the pituitary gland.
The only possible treatment option is surgery. So, the neurosurgeon performs excision via craniotomy for the complete removal of the tumor. During the surgery, the surgeon also employs an operating microscope for microsurgery. In this scenario, the billing department can bill the surgery with CPT code 61545 as the primary code along with code 69990.
Suture of the Digital Nerve
Suppose a mechanic arrives at the emergency room. He has numbness and loss of sensation in his right index finger following a deep laceration from a tool slip. Examination reveals a severed digital nerve, causing impaired function and pain. To restore nerve continuity and sensation, the surgeon opts for direct suture repair under magnification, as it ensures accurate alignment of nerve fascicles.
The medical billing department codes and submits the claim for reimbursement. In this case, CPT code 69990 is used along with the primary code CPT 64831.
Applicable Modifiers for CPT Code 69990
The following are some modifiers that can be appended to the CPT code 69990:
Modifier 59 or XU
The modifier 59 or XU is used to designate a “Separate Procedure”. You can use modifier 59 or XU with 69990. However, it must be done if specific requirements are met. The following is the criteria for modifier usage:
Basic Rule: You cannot bill CPT code 69990 with CPT codes 61781-61783 (computer-assisted navigation) by itself.
Exception: You can add modifier 59 (or XU) to CPT code 69990 only if both of these conditions are met:
- You used the operating microscope for a DIFFERENT procedure on the same day – not for the computer-assisted navigation procedure.
- That other procedure is one of the specific procedures that Medicare allows to be billed separately with code 69990.
Modifier 22
You can also use modifier 22 (increased procedural services) with your 69990 claims in specific conditions. Here’s a scenario in which modifier 22 is applicable:
You perform two procedures using the microscope on the same day. However, only one surgery is on Medicare’s approved list for a separate microscope payment. Your claim gets denied because the computer system doesn’t know which procedure the microscope code (69990) goes with.
In this case, you can add a modifier 22 to the CPT code of the procedure where you actually used the microscope (the one on Medicare’s approved list), and submit the claim to your MAC.
Note:
- Modifier 51 (Multiple Procedures) should never be appended to CPT code 69990.
- Modifier 50 (Bilateral Procedure) does not apply to 69990. Also, don’t bill more than 1 unit of 69990 for an operating session, regardless of the times the microscope was used.
CPT Code 69990 – Billing & Reimbursement Guidelines
The following are some essential billing guidelines for CPT code 69990:
Provide Detailed Documentation
Justifying the use of an operating microscope is crucial for proper reimbursement. Without supporting documentation, your claims are sure to be denied. The operative report must clearly document that microsurgical techniques were employed and that the operating microscope was medically necessary for the successful completion of the procedure.
Generic statements about microscope usage are insufficient. The documentation should specify the microsurgical techniques performed.
Follow the Billing Limitations
CPT code 69990 has very stringent billing requirements. Medicare has limited the use of this code to specific primary procedural codes. According to the 2022 NCCI policy manual, 69990 can be used with the following codes:
- 61304-61546
- 61550-61711
- 62010-62100
- 63081-63308
- 63704-63710
- 64831
- 64834-64836
- 64840-64858
- 64861-64868
- 64885-64891
- 64905-64907
The table below contains all the CPT codes that should not be billed with code 69990:
| Non-Applicable Codes with CPT 69990 | |
|---|---|
| 15756-15758 | 31546 |
| 15842 | 31561 |
| 19364 | 31571 |
| 19368 | 43116 |
| 20955-20962 | 43180 |
| 20969-20973 | 43496 |
| 22551 | 46601 |
| 22552 | 46607 |
| 22856-22861 | 49906 |
| 26551-26554 | 61548 |
| 26556 | 63075-63078 |
| 31526 | 64727 |
| 31531 | 64820-64823 |
| 31536 | 65091-68850 |
| 31541 | 0184T |
| 31545 | 0308T |
Source: AAO-HNS
Verify Reimbursement Rate
The reimbursement amount for CPT code 69990 varies for each MAC locality. The national average reimbursement amount for 69990 is $211.87 for facility settings.
You can check the exact reimbursement rate for your MAC locality via the PFS Lookup Tool.
Wrapping Up
Let’s wrap up everything we have discussed. CPT code 69990 is an add-on code used for microsurgical techniques that require an operating microscope. It should not be billed independently and must always be accompanied by a primary code. For proper reimbursement, always append the necessary modifiers and documentation with your claims.
Hopefully, with the help of this guide, you can successfully file claims for 69990. However, even with all the information, denials can still happen. That’s why it is always advisable to get professional neurosurgery billing services from vendors like MediBillMD.
