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Osseointegrated Implant of the Skull CPT Coding

osseointegrated implant of the skull coding

The Coding Challenge

Question:

A 12-year-old female patient with aural atresia and maximal conductive hearing loss is seen for a transcutaneous magnetic-based osseointegrated implant of the skull. The implant is placed on the affected side outside the mastoid. Select the appropriate procedure code.

A. 69930
B. 69710
C. 69714
D. 69729

Answer:

D. 69729

69729, Implantation, osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, outside of the mastoid and resulting in removal of greater than or equal to 100 sq mm surface area of bone deep to the outer cranial cortex

In this scenario, transcutaneous implantation of the osseointegrated device is placed in the skull with magnetic attachment to the external speech processor, outside the mastoid.

Other Names for Osseointegrated Implants of the Skull

Osseointegrated Implants of the Skull are also called auditory osseointegrated implants (AOI), osseointegrated bone prostheses, bone-conduction hearing devices (BCHD), bone-anchored hearing aids (BAHA), and bone-anchored hearing devices (BAHD).

Why Would a Transcutaneous Auditory Osseointegrated Implant Be Performed?

Individuals who cannot adjust to traditional hearing aids may find a surgical osseointegrated skull implant a popular alternative.

According to the National Library of Medicine, a transcutaneous auditory osseointegrated implant is a type of surgical procedure that is often performed in patients who have aural atresia with maximal conductive hearing loss. Maximal conductive hearing loss is generally about 60 dB HL (decibel hearing level).

The purpose of the procedure is to potentially restore hearing on the affected side. The surgeon, often an otolaryngologist, can perform the procedure on an outpatient basis in about two to three hours.

Definitions

Conducive hearing loss is a type of hearing loss caused by damage or obstruction in the outer or middle ear. Damage or obstruction prevents the sound from being effectively conducted from the environment and into the cochlea, the hearing part of the inner ear.

According to ENT Health, there are different causes of conductive hearing loss; aural atresia is included in these potential causes. Aural atresia is a congenital birth defect of the ear and results in hearing loss due to the absence or underdevelopment of an ear canal and middle ear structures. Atresia may or may not be accompanied by another congenital birth defect called microtia. Microtia is the absence of the ear or the underdevelopment of the outer ear.

Locate and Verify

In the CPT Index, look under Osseointegrated Implant, Implantation, 69714, 69716, 69729. 

When we look up these codes in the Tabular, we can see that our correct code is:

69729, Implantation, osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, outside of the mastoid and resulting in removal of greater than or equal to 100 sq mm surface area of bone deep to the outer cranial cortex

Code 69714 describes a percutaneous auditory osseointegrated implant (AOI) with an abutment.

Code 69716 describes a transcutaneous AOI in which the device is placed in the skull with a magnetic attachment to the external speech processor within the mastoid.

Replacement and removal of a transcutaneous AOI are reported with codes 69630 and 69728, respectively. 

Incorrect Answers

A, B, and C are incorrect.

A. 69930 refers to Cochlear device implantation, with or without mastoidectomy.

B. 69710 refers to Implantation or replacement of electromagnetic bone conduction hearing device in temporal bone. 

C. 69714 refers to Implantation, osseointegrated implant, skull; with percutaneous attachment to external speech processor.

Additional Information on Osseointegrated Skull Implants

How Does an Osseointegrated Skull Implant Work and What is “Osseointegration”?

A surgical osseointegrated skull implant is a type of hearing aid that bypasses the middle ear and treats hearing loss through a process called “osseointegration.” According to StatPearls Publishing, osseointegration involves the bone conduction hearing device or prosthesis being implanted directly into the temporal bone and merging with the skull over a period of three to six months. This allows the amplified and processed sound to be conducted via the skull bone directly to the cochlea.

image of percutaneous and transcutaneous bone conduction device systems
Two percutaneous and two transcutaneous bone conduction device systems with vibratory components external to the patient.

Two Methods for Placing an Osseointegrated Skull Implant

The implant may be placed either percutaneously (through the skin) with an abutment or transcutaneously (across the skin and bone) with a magnet.

Percutaneous implant with an abutment. A titanium screw is placed into the skull bone behind the deaf ear, which attaches to an abutment. A skin punch is performed to exteriorize the abutment. An external sound processor captures sound from the environment and transmits signals to the implant as sound vibrations. The implant subsequently enables the cochlea in the inner ear to receive these vibrations, resulting in improved hearing.

image of transcutaneous auditory osseointegrated implant with description of the different components
The Cochlear BAHA Attract System above is one example of a magnetic auditory osseointegrated system.

Transcutaneous implant with a magnet. Although similar to the percutaneous implant, the transcutaneous method does not require a percutaneous punch since there is no protruding abutment. Instead, the transcutaneous implant system consists of a titanium implant, an internal magnet, an external magnet, and a sound processor. The external sound processor connects with a magnetic connection to the implant. 

Usually, the transcutaneous implant is placed within the mastoid part of the temporal bone. However, there are cases when it must be placed outside of the mastoid. For example, a patient lacks a mastoid or has a disease that prevents insertion into the mastoid.

CPT Codes Are in the Osseointegrated Implants Subsection

CPT codes for auditory osseointegrated implants (AOI) are located in the CPT Codebook under the Surgical Procedures on the Auditory System/Middle Ear section within the Osseointegrated Implants subsection.

These codes are further classified as to the treatment method (i.e., implantation, replacement, or removal), and the technique used (i.e., percutaneous with an abutment or transcutaneous with a magnet). Furthermore, the codes for transcutaneous techniques are based on whether the device is placed inside or outside the mastoid. 

The CPT codebook provides the following guideline as it relates to the implantation of an osseointegrated implant and codes 69714, 69716, and 69729:

“The following codes are for implantation of an osseointegrated implant into the skull. These devices treat hearing loss through surgical placement of an abutment or device into the skull that facilitates transduction of acoustic energy to be received by the better-hearing inner ear or both inner ears when the implant is coupled to a speech processor and vibratory element. This coupling may occur in a percutaneous or a transcutaneous fashion. Other middle ear and mastoid procedures (69501-69676) may be performed for different indications and may be reported separately when performed.”

Replacement (including removal of an existing device) of the device is reported with a code from range 69717-69730. Removal of the device is reported with a code from range 69726-69728.

Modifiers Indicating Laterality

When the documentation indicates which side of the body the implant is placed on, it should be reflected by appending either modifier -LT (left) or -RT (right) to the CPT code. Furthermore, bilateral implants should be reported using either modifier -50 or -LT and -RT.


How did you do? If you had a little trouble, no worries. Go back and read the question again and review the information provided. Refer to your CPT Codebook for the guidelines related to reporting for auditory osseointegrated implants. It just takes time and practice!

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