Notification



Notification Issue Date:



Claim Payment Policy


Title:Use of an Operating Microscope During a Surgical Procedure

Policy #:11.00.11k

This policy is applicable to the Company’s commercial products only. Policies that are applicable to the Company’s Medicare Advantage products are accessible via a separate Medicare Advantage policy database.

Application of Claim Payment Policy is determined by benefits and contracts. Benefits may vary based on product line, group or contract. Medical necessity determination applies only if the benefit exists and no contract exclusions are applicable. Individual member benefits must be verified.

In products where members are able to self-refer to providers for care and services, members are advised to use participating providers in order to receive the highest level of benefits.When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.

For more information on how Claim Payment Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.



Policy

The use of an operating microscope during a surgical procedure is covered and eligible for separate reimbursement consideration by the Company to the professional provider when reported in conjunction with the primary procedure codes included in Attachment A.

When reported with any other primary procedure code, the use of an operating microscope during a surgical procedure is not eligible for separate reimbursement.
Guidelines

The procedure code to report the use of an operating microscope is an add-on code and should not be reported alone.

It is not appropriate to report the use of an operating microscope when magnifying loupes or corrected vision lenses are used during a surgical procedure.

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, the use of an operating microscope during a surgical procedure is covered under the medical benefits of the Company's products.

Description

An operating microscope is a two-headed magnifying device with a standard position that can be operated by hand or foot. An 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. An operating microscope can be used for the entire surgical procedure or only for certain portions of the surgery.

An operating microscope is different from magnifying loupes, which are glasses worn during surgical procedures to facilitate vision.
References


Centers for Medicare and Medicaid Services (CMS). Medicare Claims Processing Manual. Chapter 12: Physicians/Nonphysicians practitioners. 20.4.5: Allowable adjustments (B3-15055). [CMS Web site]. 10/01/03. Available at: http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf. Accessed October 15, 2006.

Company Benefit Contracts.

Townsend CM, Beauchamp RD, Evers BM, Mattox KL, Sabiston Textbook of Surgery. 16th ed. Philadelphia, PA: W.B. Saunders; 2001:1556.




Coding

Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

69990


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD-10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD-10 Diagnosis Code Number(s)

N/A


HCPCS Level II Code Number(s)

N/A


Revenue Code Number(s)

N/A

Coding and Billing Requirements


Cross References

Attachment A: Use of an Operating Microscope During a Surgical Procedure


Policy History

REVISIONS FROM 11.00.11k:
01/01/2019This policy has been identified and updated for the CPT code update effective 01/01/2019.

The following CPT codes have been deleted from the policy: 61332, 61480, 61610, 61612, 66220.

Narratives for the following CPT codes have been revised in this policy: 61641, 61642.

REVISIONS FROM 11.00.11j:
01/01/2018This policy has been identified for the CPT code update, effective 01/01/2018.

The following CPT narratives have been revised in this policy: 76000:


Effective 10/05/2017 this policy has been updated to the new policy template format.


Version Effective Date: 01/01/2019
Version Issued Date: 01/11/2019
Version Reissued Date: N/A

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Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.