Otolaryngology Coding Alert

Come to your own conclusions, but don’t veer from the official guidance.

While authoritative guidance updates, such as those monthly updates from AMA’s CPT ^®Assistant, are designed to make the job of the specialty coder easier, it’s not always that simple. In some instances, new coding instruction can interfere with what was a previously smooth working coding dynamic for a given procedure.

In fact, that’s exactly what happened in a January 2019 issue of CPT^® Assistant, in which a seemingly benign response to a question on the coding of bone-anchored hearing aid (BAHA) procedures fundamentally changed the way ENT practices billed, and were compensated for, those respective services.

Get the scoop on what’s changed, why it’s a problem, and how to remedy the situation.

See Where the Problem Originates

In CPT^® Assistant (January 2019; Volume 29: Issue 1), some concrete coding guidance was offered on how to code a service in which the provider “implanted a bone-conduction hearing system whereby sound vibrations are transferred by magnetic coupling from the external processor to the bone implant to the cochlea (inner ear).” CPT^® Assistant gave the following response:

• “Report code 69799 (Unlisted procedure, middle ear). The work of placing an osseointegrated bone-conduction hearing system that uses magnetic connection and coupling is substantially different from the work of placing a percutaneous system. Although the service performed by the surgeon involves the placement of a screw into the skull, it does not involve the creation of a percutaneous channel through which the screw protrudes and to which the processor is attached. When reporting an unlisted code to describe a procedure or service, it may be necessary to submit supporting documentation (eg, procedure report) with the claim to provide adequate description of the nature, extent, and need for the procedure; and the time, effort, and equipment necessary to provide the service.”

For those ENT practices that don’t perform such procedures, this Q&A may have been dismissed or overlooked. But those coders and performing providers who are fluent with the operative dynamics surrounding BAHA procedures detailed numerous concerns with not only the coding guidance, but how such guidance will complicate reimbursement.

Break Down Each Respective Procedure

Before diving into the underlying issues ENT practices and specialty societies take up with the guidance, you should have a firm understanding of how the procedure detailed in the above CPT^® Assistant question differs from traditional BAHA procedures outlined by codes 69714 (Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/ cochlear stimulator; without mastoidectomy) and 69715 (… with mastoidectomy).

According to the International Journal of Audiology, magnetic coupling is used in place of a skin-penetrating hearing implant in order to hold the external sound processor in place and transmit acoustic energy. Furthermore, “an implantable magnet is anchored to the skull via a single osseointegrated fixture, maximizing the efficiency of energy sound transfer.”

This technique varies in contrast to the percutaneous attachment as a less invasive, and arguably more practical alternative. However, outside of the underlying difference of magnetic placement versus an attachment via an incision through the skin, the procedures aren’t considerably different. It’s for this reason that the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS) and the American Otological Society (AOS) submitted the following response to the CPT^® Assistant Editorial Board arguing against 69799 reporting for BAHA procedures that use magnetic coupling:

• “We disagree that 69799 should be used to report procedures to implant an osseointegrated device into the temporal bone. After surveying the membership of both societies, our members report that the current codes (69714 and 69715) are applicable to all BAHA devices currently on the market. The surgeons we surveyed felt that despite minor differences in the actual steps needed to insert the device, the times are nearly identical and the work is the same.”

Keep an Eye Out for Updated Guidance

While the otolaryngology community is seemingly unanimous in its dissent from this guidance, the CPT^® 2021 updates don’t include any changes in the guidelines, code descriptions, or otherwise, to suggest that the CPT^® Editorial Panel took these concerns to heart. Rather, until you see either a CPT^® Assistant update, a revised 69714/69715 code description, or a new Category I or Category III code, you should stick to the CPT^® Assistant guidance on reporting 69799 for BAHA procedures that involve magnetic coupling. In order to improve your chances for deserved reimbursement, you should submit the claim on paper and include code 69714 or 69715 as a comparison code in Box 19 of the CMS-1500 form.