procedure code and description
CPT 10040 ACNE SURGERY
69990- Microsurgical techniques, requiring use of operating microscope – average fee payment – $260 – $270
64727 Internal neurolysis, requiring use of operating microscope
Note: The below list is for commonly performed surgical procedures and is intended as representative; not all-inclusive.
10040 Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules)
11200 Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions
11201 Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure))
11300-11313 Shaving of epidermal or dermal lesion, single lesion, trunk, arms, legs, scalp, neck, hands, feet, genitalia, face, ears, eyelids, nose, lips, mucous membrane
11920– 11922 Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including
micropigmentation
11950– 11954 Subcutaneous injection of filling material (eg, collagen)
DEFINITIONS
Microsurgery: The use of a microscope during a surgical procedure to perform Microsurgical Technique.
Microsurgical Technique: A surgical technique for dissecting tissues under a microscope.
Same Individual Physician, Hospital, Ambulatory Surgical Center or Other Health Care Professional: The same individual physician, hospital, ambulatory surgical center or other health care professional rendering health care services reporting the same Federal Tax Identification number.
Procedure Code 69990
CMS reimbursement guidelines differ from the Procedure book coding guidelines. Oxford follows CMS reimbursement guidelines for reimbursement of 69990 with certain nervous system surgeries.
Oxford will reimburse Procedure code 69990 when billed in conjunction with services described in the list of Services Allowed with Procedure 69990.
DESCRIPTION
An operating microscope is a two-headed magnifying device with a standard position that can be operated by hand or foot. The operating microscope is used during a specialized type of surgery known as microsurgery.
Microsurgery involves magnification, microinstrumentation, microsutures, and meticulous techniques to repair or restore tissues. The use of an operating microscope significantly enlarges and enhances the surgeons’ view. Procedure has designated code 69990 as an add-on code to report an operating microscope. 69990 should be reported (without modifier 51 appended) in addition to the code for the primary procedure performed. The operating microscope can be used for the entire surgical procedure or only for certain portions of the surgery; however, it is reimbursed only once per operative session regardless of the number of surgeries performed.
The Centers for Medicare & Medicaid Services (CMS) guidelines for payment of Procedure code 69990 differ from Procedure Manual instructions following Procedure code 69990. CMS Correct Coding Initiative (CCI) edits deny separate reimbursement for 69990 even when billed in combination with some of the valid primary procedure codes provided in the Procedure guidelines.
The CMS/CCI guidelines are more restrictive because the use of the operating microscope has over time become the standard of care for many surgical procedures. In many cases, CMS has considered the work associated with the use of the operating microscope when calculating the Relative Value Unit (RVU) for the primary surgical procedure code. National Correct Coding Initiative (NCCI) edits bundle Procedure code 69990 into surgical procedures with RVU values inclusive of the operating microscope. Most of these edits do not allow use of NCCI-associated modifiers.
QUESTIONS AND ANSWERS 1
Q: Why does Oxford choose to follow the Centers for Medicare and Medicaid Services (CMS) guidelines rather than the Procedure book guidelines for bundling of code 69990?
A: More consistency was found in the CMS bundling rules. For example, CMS consistently considers 69990 included in eye and ear surgical procedures, while Procedure varies within these Procedure sections.
2 Q: Why does Oxford include add-on codes in the Services Allowed with Procedure 69990 list when CMS National Correct Coding Initiative (NCCI) does not include these add-on codes in the range of services in which Procedure code 69990 is allowable?
A: CMS guidelines state, “In general, NCCI procedure to procedure edits do not include edits with most add-on codes because edits related to the primary procedure(s) are adequate to prevent inappropriate payment for an add-on coded procedure.” Oxford aligns with CMS and allows reimbursement of Procedure code 69990 reported with add-on codes when the primary procedure codes are allowable. For example, primary procedure code 61304 (Craniectomy or craniotomy, exploratory; supratentorial) is allowable and, therefore, add-on code 61316 (Incision and subcutaneous placement of cranial bone graft (List separately in addition to code for primary procedure) is also allowable.
Section Code Range Subsection Code Count
10040 69990 Section Total 5073
10021 10022 General 2
10040 19499 Integumentary System 372
20000 29999 Musculoskeletal System 1525
30000 32999 Respiratory System 271
33010 37799 Cardiovascular System 543
38100 38999 Hemic and Lymphatic Systems 49
39000 39599 Mediastinum and Diaphragm 18
40490 49999 Digestive System 763
50010 53899 Urinary System 302
54000 55899 Male Genital System 143
55970 55980 Intersex Surgery 2
56405 58999 Female Genital System 180
59000 59899 Maternity Care and Delivery 59
60000 60699 Endocrine System 30
61000 64999 Nervous System 449
65091 68899 Eye and Ocular Adnexa 267
69000 69979 Auditory System 97
69990 69990 Operating Microscope 1
