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Orthopedic Coding Alert


Payer Policy Dictates Microscope Coding

Question: Our surgeon used an operating microscope for dissection during single-level decompression, hemilaminectomy, and partial facetectomy in the lumbar region. Can we bill both the procedure and microscope use since the patient is non-Medicare? North Dakota Subscriber Answer: You can report both codes if the payer's guidelines allow it. If so, submit 63030 (Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, including open and endoscopically-assisted approaches; 1 interspace, lumbar) and +69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure]). Edit watch: The Correct Coding Initiative (CCI) edits bundle +69990 into 63030 and do not allow you to break the bundle with a modifier. Many individual payers also have policies stating that the microscope use is an inherent part of 63030. If the payer in question follows CCI edits or has its own policy [...]

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