How To Use CPT Code 69990

CPT 69990 refers to the use of an operating microscope for microsurgical techniques during a primary procedure. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 69990.

1. What is CPT 69990?

CPT 69990 is an add-on code used to report the use of an operating microscope during a primary surgical procedure. This code is billed in addition to the primary procedure code when microsurgical techniques are employed, requiring the use of an operating microscope for enhanced visualization and precision.

2. 69990 CPT code description

The official description of CPT code 69990 is: “Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure)”.

3. Procedure

  1. Surgeon prepares the surgical site and positions the patient.
  2. Operating microscope is set up and adjusted for optimal visualization.
  3. Surgeon performs the primary procedure using microsurgical techniques and instruments.
  4. Operating microscope is used to facilitate precise cutting, suturing, and manipulation of tissues.
  5. Upon completion of the primary procedure, the operating microscope is removed, and the surgical site is closed.

4. Qualifying circumstances

Eligibility for CPT 69990 services is determined by the following criteria:

  • The operating microscope is used during a primary surgical procedure.
  • Microsurgical techniques are employed, requiring the use of the operating microscope for enhanced visualization and precision.
  • The primary procedure code allows for the addition of CPT 69990, as per payer guidelines.
  • Proper documentation is provided to support the claim for CPT 69990.

5. When to use CPT code 69990

It is appropriate to bill CPT code 69990 when the following conditions are met:

  • The provider uses an operating microscope during a primary surgical procedure.
  • Microsurgical techniques are employed, necessitating the use of the operating microscope for enhanced visualization and precision.
  • The primary procedure code allows for the addition of CPT 69990, as per payer guidelines.
  • Proper documentation is provided to support the claim for CPT 69990.

6. Documentation requirements

To support a claim for CPT 69990, the following information must be documented:

  • A detailed description of the primary surgical procedure performed.
  • Specific mention of the use of an operating microscope during the procedure.
  • Explanation of the microsurgical techniques employed and their necessity for the procedure.
  • Any relevant operative notes, including the type of operating microscope used (e.g., Weck® scope, Zeiss® scope, or Leica®).

7. Billing guidelines

When billing for CPT code 69990, keep in mind the following guidelines:

  • Report CPT 69990 separately in addition to the primary procedure code.
  • Only bill CPT 69990 once per operative session, regardless of the number of procedures performed using the operating microscope.
  • Do not append modifier 51 (Multiple procedures) to CPT 69990, as it is an add-on code.
  • Check payer guidelines to ensure the primary procedure code allows for the addition of CPT 69990.
  • Do not report CPT 69990 when the provider uses loupes or vision correction instead of an operating microscope.

8. Historical information

CPT 69990 was added to the Current Procedural Terminology system on January 1, 1999. The code descriptor was changed on January 1, 2002, from “Use of operating microscope (List separately in addition to code for primary procedure)” to its current description.

9. Similar codes to CPT 69990

Five similar codes to CPT 69990 and how they differ are:

  • CPT 69930 – Involves cochlear device implantation with or without mastoidectomy.
  • CPT 61782 – Pertains to computer-assisted navigation during cranial, spinal, or other intracranial procedures.
  • CPT 64999 – Represents an unlisted procedure for the nervous system, not specifically defined by another CPT code.
  • CPT 69915 – Involves the use of an operating microscope during a tympanoplasty procedure.
  • CPT 69979 – Refers to the use of an operating microscope during a stapedectomy or stapedotomy procedure.

10. Examples

  1. Microsurgical repair of a complex nerve injury using an operating microscope.
  2. Removal of a small brain tumor with the aid of an operating microscope.
  3. Microsurgical revascularization of a blocked artery using an operating microscope.
  4. Reattachment of a severed finger using microsurgical techniques and an operating microscope.
  5. Microsurgical repair of a damaged cornea with the assistance of an operating microscope.
  6. Excision of a small spinal cord tumor using microsurgical techniques and an operating microscope.
  7. Microsurgical reconstruction of a damaged blood vessel using an operating microscope.
  8. Repair of a complex facial fracture using microsurgical techniques and an operating microscope.
  9. Removal of a small acoustic neuroma with the aid of an operating microscope.
  10. Microsurgical repair of a damaged inner ear structure using an operating microscope.

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