Otolaryngology Coding Alert

The December Otolaryngology Coding Alert listed four new codes that describe either implantation or replacement of osseointegrated implants (page 89, CPT 2001 Promises Greater Reimbursement With the Addition of New Otolaryngology Codes). Some of the information about these codes, however, was incomplete, says Lee Eisenberg, MD, an otolaryngologist in Englewood, N.J., and a member of CPTs editorial panel and executive committee. To clarify when these codes should be used, Eisenberg contacted neuro-otologist John Niparko, MD, a professor in the Johns Hopkins School of Medicine and director of The Listening Center, the Johns Hopkins cochlear implant program. Niparko played an important role in obtaining CPT codes for the procedures and in determining their relative value in the 2001 HCFA fee schedule.

The four codes are:

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); and

69718 . . . with mastoidectomy.

According to Niparko, The osseointegrated mastoid implant and attached percutaneous abutment are indicated for restoration of hearing in cases of ear canal stenosis, ear canal atresia, middle ear disease or combined middle ear and cranial n. VIII disease. This approach to prosthetic stimulation of the cochlea is indicated in patients with moderate to severe hearing loss when conventional amplification produces recurrent infection, or when anomalies of the ear canal prevent effective hearing. Mastoidectomy may be required in conjunction with the implant procedure to irradicate infection or cholesteatoma.

The typical patient candidate for this implantation procedure is one with hearing loss due to chronic otitis media, otosclerosis or atresia or trauma of the ear canal who is unable to gain useful speech comprehension with a hearing aid. In many such cases, the occlusion effect of the hearing aid mold in the ear canal prevents effective sound transmission and the normal ventilation required to maintain a safe, dry ear. The osseointegrated implant provides the means for later percutaneous attachment of a speech processor-stimulator. The implant has the capability of restoring a sensitive level of hearing without introducing a mold or prosthetic material in the external ear canal, and does not require invasion of the middle ear or cochlea, Niparko concludes.

Although these procedures are well reimbursed (69714, 23.68 RVUs; 69715, 29.99 RVUs; 69717, 24.39 RVUs; and 69718, 30.35 RVUs), HCFA has yet to make a national policy decision regarding coverage of these services, Niparko says, and that leaves local Medicare carriers responsible for coverage decisions.

Eisenberg, meanwhile, advises otolaryngologists to call their carriers Medicare or third-party to determine their specific payment policies before performing any of these elective procedures.