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The CPT® Code 69714 refers to the procedure of implanting an osseointegrated implant in the skull, which includes the installation of a percutaneous attachment for an external speech processor. This procedure is primarily utilized in the context of bone conduction implants (BCI), which are designed to assist individuals with hearing impairments. The BCI system operates by using an external hearing aid or speech processor that amplifies sound. This amplified sound is then transmitted to an implant that is anchored to the skull, allowing sound vibrations to be conducted through the bone directly to the cochlea, the auditory portion of the inner ear. In the case of percutaneous implants, the surgical approach involves making an incision that can either be a vertical line measuring between 1 to 1.5 cm or a circular incision with a diameter of 5 mm. The surgical site is strategically planned to be at a height that aligns with the top of the auricle, typically around 5.5 cm from the ear canal. The procedure requires careful preparation, including the removal of hair from the surgical area and the use of a small gauge needle to measure the soft tissue depth down to the bony cortex. This measurement is critical as it informs the selection of the appropriate abutment size, which is determined by adding three millimeters to the measured depth. Local anesthesia is administered to ensure patient comfort during the procedure. The incision is then deepened to reach the bone, and the periosteum, a layer of connective tissue surrounding the bone, is elevated. Depth-gauging drill bits are employed to confirm that the bone thickness at the site is adequate for the implant. Once the correct depth is established, a countersink drill bit is utilized to create a well in the skull where the implant will be anchored. The implant is then securely placed, and if it does not come with a precoupled abutment, a separate abutment is attached to the implant. The surrounding soft tissue is meticulously closed in multiple layers, or alternatively, the surgical site may be closed entirely with the skin being removed over the abutment. This allows for the external speech processor and microphone to be affixed to the abutment, which is designed to permanently project from the patient's head, facilitating the connection to the external components of the hearing device.
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The procedure described by CPT® Code 69714 is indicated for patients who require assistance with hearing due to conductive hearing loss, mixed hearing loss, or single-sided deafness. It is particularly beneficial for individuals who cannot use traditional hearing aids due to anatomical or medical reasons. The implantation of an osseointegrated implant with a percutaneous attachment to an external speech processor is aimed at improving auditory perception and communication abilities in these patients.
The procedure for CPT® Code 69714 involves several critical steps to ensure the successful implantation of the osseointegrated implant. Initially, the surgical site is prepared, which includes the removal of hair from the area where the implant will be placed. The surgeon then marks the incision site, which is typically located at a height that aligns with the top of the auricle, approximately 5.5 cm from the ear canal. A small gauge needle is inserted to measure the soft tissue depth down to the bony cortex, which is essential for determining the appropriate size of the abutment. An additional three millimeters is added to this measurement to ensure a proper fit. Once the measurements are confirmed, local anesthetic is administered to the patient to minimize discomfort during the procedure. The incision is made, either as a vertical line of 1-1.5 cm or as a circular cut with a diameter of 5 mm, and is carried down to the bone. The periosteum is then elevated to expose the underlying bone. Depth-gauging drill bits are utilized to assess the thickness of the bone at the site, ensuring it is adequate for the implant. After confirming the appropriate depth, a countersink drill bit is employed to create a well in the skull where the implant will be anchored. The implant is then securely placed into this well. If the implant does not come with a precoupled abutment, the abutment is attached separately to the implant. Following this, the soft tissue surrounding the abutment is closed in multiple layers to promote healing. Alternatively, the surgical site may be closed entirely, with the skin being removed over the abutment to allow for the external speech processor and microphone to be connected. The abutment is designed to permanently project from the patient's head, facilitating the attachment of the external components of the hearing device.
After the implantation procedure is completed, patients are typically monitored for any immediate complications. Post-procedure care includes instructions for wound care to ensure proper healing of the surgical site. Patients may be advised to avoid strenuous activities and to keep the area clean and dry. Follow-up appointments are essential to assess the healing process and to ensure that the implant is integrating properly with the bone. Once healing is sufficient, the external speech processor can be fitted and adjusted to optimize hearing performance. Patients may also receive guidance on how to care for the external components and what to expect during the recovery period.
| Short Descr | IMPL OI IMPLT SKULL PERQ ESP | Medium Descr | IMPL OI IMPLT SKULL PERQ ATTACHMENT ESP | Long Descr | Implantation, osseointegrated implant, skull; with percutaneous attachment to external speech processor | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 26 - Other therapeutic ear procedures |
| RT | Right side (used to identify procedures performed on the right side of the body) | 50 | Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 74 | Discontinued out-patient hospital/ambulatory surgery center (asc) procedure after administration of anesthesia: due to extenuating circumstances or those that threaten the well being of the patient, the physician may terminate a surgical or diagnostic procedure after the administration of anesthesia (local, regional block(s), general) or after the procedure was started (incision made, intubation started, scope inserted, etc). under these circumstances, the procedure started but terminated can be reported by its usual procedure number and the addition of modifier 74. note: the elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. for physician reporting of a discontinued procedure, see modifier 53. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | SG | Ambulatory surgical center (asc) facility service |
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| 2024-01-01 | Changed | Guideline added. |
| 2023-01-01 | Note | Short and medium descriptions changed. |
| 2022-01-01 | Changed | Code description changed. |
| 2001-01-01 | Added | First appearance in code book in 2001. |
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