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Coding Operating Microscopes

An operating or surgical microscope is a specific type of surgical instrument which is different from magnifying loupes, corrected vision devices, or other simple magnification devices. An operating microscope is also not the same as a robotic surgical device.

The operating microscope is employed to enhance visualization during some surgical procedures, e.g. those using the techniques of microsurgery. The use of an operating microscope has become the standard of surgical care for many surgical procedures.

CPT® guidelines disallows  +69990 Microsurgical techniques, requiring use of operating microscope (list separately in addition to code for primary procedure) in addition to any procedure that includes microsurgical techniques as part of the code descriptor (e.g., 22856Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection; single interspace, cervical).

These “disallowed” primary codes are listed in a parenthetical note preceding the code and its descriptor in the CPT® Codebook.

CPT code 69990 should only be reported when the surgeon performs a procedure that requires microsurgery or microdissection.

CPT code 69990 should not be used if the surgeon uses the microscope only for magnification or illumination.

CPT code 69990 is eligible for separate reimbursement only to provider types which CMS has designated as eligible for separate reimbursement for CPT code 69990 (operating microscope).

CPT code 69990 is eligible for separate reimbursement only with procedure codes that CMS has designated as eligible with operating microscope.

CPT code 69990 is eligible for reimbursement a maximum of once per operative session (one unit), not per procedure code.

Note that Centers for Medicare & Medicaid Services (CMS) regulations limit the reporting of 69990 to far fewer instances than CPT®. In many cases Medicare considers the operating microscope to be bundled to the primary procedure, in opposition to AMA guidelines. When reporting 69990 to Medicare, payers need to check the National Correct Coding Initiative (NCCI) to be sure that use of operating microscope is not bundled to the primary procedure code.  CPT code 69990 will be denied to provider liability when submitted with codes not on the CMS list. Bundling edits based on NCCI edits apply to all lines of business.

Note: CPT is a registered trademark of the American Medical Association.