Surgery CPT codes 10040 - 69990, 64727

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.

OVERVIEW

Microsurgical Technique is the use of an operating microscope during a surgical procedure. Use of an operating microscope, reported with Current Procedural Terminology (Procedure ) codes 64727 and 69990, is a reimbursable service in specified instances.

For the purpose of this policy, the Same Individual Physician, Hospital, Ambulatory Surgical Center or Other Health Care Professional is the same individual physician, hospital, or ambulatory surgical center rendering health care services reporting the same Federal Tax Identification number.


REIMBURSEMENT GUIDELINES

Procedure  Code 64727

Consistent with the Procedure  book coding guidelines for Procedure  code 64727, Oxford will only reimburse Procedure  code 64727 when submitted with internal neurolysis codes on the list of Services Allowed with Procedure  64627. 

The Centers for Medicare and Medicaid Services (CMS) Medicare Claims Processing Manual and the Correct Coding Initiative (CCI) state that Procedure  code 69990 is not to be reported in addition to Procedure  code 64727.

Codes 64727 Internal neurolysis, requiring use of operating microscope (List separately in addition to code for neuroplasty) (Neuroplasty includes external neurolysis) 69990 Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure) Attachments: Please right-click on the icon to open the file.

Services Allowed  with 64727 This list contains the Procedure  codes for services that are reimbursed when submitted with Procedure  code 64727.

Services Allowed with 69990 This list contains the Procedure  codes for services that are reimbursed when submitted with Procedure  code 69990.

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

No comments:

Medical Billing Popular Articles