Otolaryngology Coding Alert

Question: My practice is doing an implantation of electromagnetic bone conduction hearing device in temporal bone, which has a code of 69710. However, the procedure is not exactly how we are doing it. If we are not doing all the work in the description, how should I report the procedure?

North Carolina Subscriber

Answer: If you're not doing all the components described for a code -- in this case, 69710 (Implantation or replacement of electromagnetic bone conduction hearing device in temporal bone) -- you should append modifier 52 (Reduced services) and state that you only did parts of what is described for the code. Understandably, payers do not reimburse for the parts that you're not doing, but may ask for supporting documentation.

Another option: In Florida, the only code that Medicare reimburses for electromagnetic bone conduction device implantation is 69714 (Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; without mastoidectomy). It is strictly for very specific ICD codes and requires prior authorization. "Medical necessity" has a number of interpretations, but Medicare defines the term as "services and items reasonable and necessary for the diagnosis and treatment of illness and injury or to improve the functioning of a malformed body part."

-- Answers to You Be the Coder and Reader Questions provided/reviewed by Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.