Question:
Brooke_STAT
Per Medicare's Jan 2015 updates, when billing CPT 69990 (use of microscope) append the -22 modifier to the procedure in which the microscope was for. The -22 modifier would typically increase the reimbursement and because we are already billing for the use microscope would just the need for it justify the use of the -22 modifier? And should I be billing it this way to other insurance companies as well?
Answer thread:
Laureen
Hi Brooke - where are you seeing guidance to append modifier 22? That doesn't sound correct to me.
Brooke_STAT
I found this information under CMS guidelines coding updates for Jan. 2015 in the section discussing the microscope. I can send you the link if you can't fin it. I also found new modifiers Medicare is requiring to take the place of the -59
Laureen
Yes a link would be appreciated.
Re modifier 59 changes we have discussed that on one of our recent webinars and have a thread on it here
https://www.cco.us/forum/threads/modifier-59-xe-xs-xp-and-xu.2517/
(https://www.cms.gov/files/document/mln1783722-proper-use-modifiers-59-xe-xp-xs-and-xu.pdf) - 2024
Brooke_STAT
http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html
(https://www.cms.gov/files/document/chapter1generalcorrectcodingpoliciesfinal11.pdf)-2022
F. Operating Microscope
1. The Internet-Only Manual (IOM), Medicare Claims Processing Manual, Publication 100-04, Chapter 12, Section 20.4.5 (Allowable Adjustments) limits the reporting of use of an operating microscope (CPT code 69990) to procedures described by CPT codes 61304-61546, 61550-61711, 62010-62100, 63081-63308, 63704-63710, 64831, 64834-64836, 64840-64858, 64861-64870, 64885-64891 and 64905-64907. CPT code 69990 should not be reported
with other procedures even if an operating microscope is utilized. CMS guidelines for payment of CPT code 69990 differ from CPT Manual instructions following CPT code 69990. The NCCI bundles CPT code 69990 into all surgical procedures other than those listed in the Medicare Claims Processing Manual. Most edits do not allow use of NCCI-associated modifiers. (CPT code 64870 was deleted January 1, 2015.)
2. If a physician performs two procedures utilizing the operating microscope but only one of the procedures is on the CMS list of procedures for which CPT code 69990 is separately payable, payment for CPT code 69990 may be denied because of an edit bundling CPT code 69990 into the other procedure not on the CMS list. (Claims processing systems do not identify which procedure is linked to CPT code 69990.) In these cases, physicians may submit the claim to the local carrier (A/B MAC processing practitioner service claims) appending modifier 22 to the CPT code for the procedure on which the operating microscope was used and a letter of explanation. Although the carrier (A/B
Revision Date (Medicare): 1/1/2015
VIII-17
MAC processing practitioner service claims) cannot override an NCCI PTP edit that does not allow use of NCCI-associated modifiers, the carrier (A/B MAC processing practitioner service claims) has discretion to adjust payment to include use of the operating microscope based on modifier 22.
Laureen
Thanks for digging that out Brooke - this makes more sense now.
So what this is saying is if you have TWO procedures and one has an edit with 69990 to put a mod 22 on the one it is NOT bundled with so the other procedre doesn't get the whole claim denied and it will be manually reviewed. It should be paid b/c it is NOT bundled in with the one procedure.
This is the key "Claims processing systems do not identify which procedure is linked to CPT code 69990." Because their system can't identify which procedure the 69990 goes with they know it would be denied incorrectly so their workaround is to have you append modifier 22 and kick it out for manual review.
The modifier 22 goes on the procedure the 69990 is NOT bundled with.
I guess modifier 22 was the best choice as it would kick it out for review and modifier 59 was not allowed.
Brooke_STAT
Per Medicare's Jan 2015 updates, when billing CPT 69990 (use of microscope) append the -22 modifier to the procedure in which the microscope was for. The -22 modifier would typically increase the reimbursement and because we are already billing for the use microscope would just the need for it justify the use of the -22 modifier? And should I be billing it this way to other insurance companies as well?
Answer thread:
Laureen
Hi Brooke - where are you seeing guidance to append modifier 22? That doesn't sound correct to me.
Brooke_STAT
I found this information under CMS guidelines coding updates for Jan. 2015 in the section discussing the microscope. I can send you the link if you can't fin it. I also found new modifiers Medicare is requiring to take the place of the -59
Laureen
Yes a link would be appreciated.
Re modifier 59 changes we have discussed that on one of our recent webinars and have a thread on it here
https://www.cco.us/forum/threads/modifier-59-xe-xs-xp-and-xu.2517/
(https://www.cms.gov/files/document/mln1783722-proper-use-modifiers-59-xe-xp-xs-and-xu.pdf) - 2024
Brooke_STAT
http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html
(https://www.cms.gov/files/document/chapter1generalcorrectcodingpoliciesfinal11.pdf)-2022
F. Operating Microscope
1. The Internet-Only Manual (IOM), Medicare Claims Processing Manual, Publication 100-04, Chapter 12, Section 20.4.5 (Allowable Adjustments) limits the reporting of use of an operating microscope (CPT code 69990) to procedures described by CPT codes 61304-61546, 61550-61711, 62010-62100, 63081-63308, 63704-63710, 64831, 64834-64836, 64840-64858, 64861-64870, 64885-64891 and 64905-64907. CPT code 69990 should not be reported
with other procedures even if an operating microscope is utilized. CMS guidelines for payment of CPT code 69990 differ from CPT Manual instructions following CPT code 69990. The NCCI bundles CPT code 69990 into all surgical procedures other than those listed in the Medicare Claims Processing Manual. Most edits do not allow use of NCCI-associated modifiers. (CPT code 64870 was deleted January 1, 2015.)
2. If a physician performs two procedures utilizing the operating microscope but only one of the procedures is on the CMS list of procedures for which CPT code 69990 is separately payable, payment for CPT code 69990 may be denied because of an edit bundling CPT code 69990 into the other procedure not on the CMS list. (Claims processing systems do not identify which procedure is linked to CPT code 69990.) In these cases, physicians may submit the claim to the local carrier (A/B MAC processing practitioner service claims) appending modifier 22 to the CPT code for the procedure on which the operating microscope was used and a letter of explanation. Although the carrier (A/B
Revision Date (Medicare): 1/1/2015
VIII-17
MAC processing practitioner service claims) cannot override an NCCI PTP edit that does not allow use of NCCI-associated modifiers, the carrier (A/B MAC processing practitioner service claims) has discretion to adjust payment to include use of the operating microscope based on modifier 22.
Laureen
Thanks for digging that out Brooke - this makes more sense now.
So what this is saying is if you have TWO procedures and one has an edit with 69990 to put a mod 22 on the one it is NOT bundled with so the other procedre doesn't get the whole claim denied and it will be manually reviewed. It should be paid b/c it is NOT bundled in with the one procedure.
This is the key "Claims processing systems do not identify which procedure is linked to CPT code 69990." Because their system can't identify which procedure the 69990 goes with they know it would be denied incorrectly so their workaround is to have you append modifier 22 and kick it out for manual review.
The modifier 22 goes on the procedure the 69990 is NOT bundled with.
I guess modifier 22 was the best choice as it would kick it out for review and modifier 59 was not allowed.