CPT Code Description
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)
Microsurgical Technique is the use of an operating microscope during a surgical procedure. Use of an operating microscope, reported with Current Procedural Terminology (CPT) 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.
CPT Code 64727
Consistent with the CPT book coding guidelines for CPT code 64727, Oxford will only reimburse CPT code 64727 when submitted with internal neurolysis codes on the list of Services Allowed with CPT 64627.
The Centers for Medicare and Medicaid Services (CMS) Medicare Claims Processing Manual and the Correct Coding Initiative (CCI) state that CPT code 69990 is not to be reported in addition to CPT code 64727.
CPT Code 69990
CMS reimbursement guidelines differ from the CPT book coding guidelines. Oxford follows CMS reimbursement guidelines for reimbursement of 69990 with certain nervous system surgeries.
Oxford will reimburse CPT code 69990 when billed in conjunction with services described in the list of Services Allowed with CPT 69990.
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.
QUESTIONS AND ANSWERS
1 Q: Why does Oxford choose to follow the Centers for Medicare and Medicaid Services (CMS) guidelines rather than the CPT 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 CPT varies within these CPT sections.
2 Q: Why does Oxford include add-on codes in the Services Allowed with CPT 69990 list when CMS National Correct Coding Initiative (NCCI) does not include these add-on codes in the range of services in which CPT 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 CPT 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.
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