Otolaryngology Coding Alert

When your otolaryngologist performs a stapedotomy and inserts a bone-anchored hearing aid (BAHA), the patient may return to your office for repairs and upgrades. Follow these steps to learn what codes you should apply,and prepare for tricky bilateral sessions.

What happens: In a stapedotomy (69660-69662,Stapedectomy or stapedotomy ...), the otolaryngologistcreates a small hole in the fixed stapes footplace and inserts a tiny, piston-like prosthesis.

BAHA (bone-anchored hearing aid) is most common.

The BAHA is a direct bone-conduction hearing aid transmitted through a titanium implant, further to the cochlea and bypassing the middle ear. Physicians now prefer to use BAHA over air-conduction hearing aids, even though the efficacy of bilateral BAHAs remains debatable.

The FDA cleared the bone-anchored hearing aid for:

• individuals aged 5 years and older who have conductive or mixed hearing loss, and

• patients with sensorineural deafness in one ear and normal hearing in the other.

You would report the BAHA insertion with additional code(s):

• 69714 -- Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; without mastoidectomy

• 69715 -- ... with mastoidectomy

• 69717 -- Replacement (including removal of existing device), osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; without mastoidectomy

• 69718 -- Replacement (including removal of existing device), osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; with mastoidectomy.

For instance, "if you actually have to replace the implant itself (the abutment and the implant), I would use the existing code 69717," says Hayes H Wanamaker, D, chief of otolaryngology at Crouse Hospital in Syracuse, N.Y.

Payers, like Aetna, may follow Medicare rules in considering BAHAs prosthetics. In other words, Medicare states "osseointegrated implants, i.e., devices implanted in the skull that replace the function of the middle ear and provide mechanical energy to the cochlea via a mechanical transducer," are prosthetics.

Bottom line: The facility that bills and codes for the supplies would report L9900 (Orthotic and prosthetic supply, accessory, and/or service component of another HCPCS L code). You should not report this.

Patients may return to your physician's office for revisions (69662, Revision of stapedectomy or stapedotomy). The primary reason for revisions of stapedectomy is hearing loss, says Julie Keene, COC, CENTC, otolaryngology coding and reimbursement specialist at the UC Health-University of Cincinnati Physicians in Ohio. The physician can do a revision for the wires of the stapes protruding through the eardrum, thus necessitating a revision stapedectomy.

If the patient requires a revision during the implant's 90-day global period, you should apply modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) to the revision code(69662). You need modifier 58 because the revision process is a normal staging procedure for the BAHA device.

If the provider implants two BAHAs in the same surgical session, your claim will have to reflect it. For instance, if the physician performed a stapedotomy, inserted a BAHA without mastoidectomy, and tested the device in each ear, you would report one of the following options:

• 69660-50 (Bilateral procedure)

• 69714-50-51 (Multiple procedures)

Option 2: Some payers want bilateral procedures on two lines.

• 69660-RT (Right side)

• 69660-50-LT (Left side)

• 69714-51-RT

• 69714-50-LT

Caution: Payers differ in coverage and coding requirements for such scenario. Call yours before you submit your claim.

Finally, your physician may see a patient to perform a revision or repair on the BAHA device. In this case, you should report a separate code.

Example: Suppose your physician changed an 8mm abutment to a 10mm abutment for a BAHA prosthetic. You would report 69399 (Unlisted procedure, external ear) and submit documentation. When in doubt that your practice may receive reimbursement, write a letter that indicates medical necessity and appeal any denial you receive.