CPT® Code 69719

Official Description

Replacement (including removal of existing device), osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, within the mastoid and/or involving a bony defect less than 100 sq mm surface area of bone deep to the outer cranial cortex

Common Language Description

The procedure described by CPT® Code 69719 involves the replacement of an osseointegrated implant in the skull, which includes the removal of an existing device. This type of implant is specifically designed for individuals with hearing loss, utilizing a bone conduction implant (BCI) system. The BCI operates by using an external hearing aid or speech processor to amplify sound, which is then transmitted through the implant anchored to the skull. This process allows sound vibrations to be conducted via the bone directly to the cochlea, facilitating improved hearing capabilities. The procedure is indicated for patients with healthy mastoid conditions, where hearing loss is not attributed to chronic infections. The replacement procedure is particularly relevant when the existing device malfunctions or requires updating. The surgical site is strategically planned to be approximately 5.5 cm behind the ear canal, aligning with the top of the auricle. This careful positioning is crucial for optimal function and aesthetic considerations. The procedure involves meticulous steps, including the creation of a subpericranial pocket for the new implant and ensuring that the surgical site is free from complications associated with the previous implant. The use of magnetic transcutaneous attachments allows for a seamless connection between the external speech processor and the internal implant, enhancing the patient's ability to engage with their environment through improved auditory input. Over time, the implant integrates with the living tissue, ensuring stability and functionality for the patient.

1. Indications

The procedure described by CPT® Code 69719 is indicated for patients who require a replacement of an osseointegrated implant due to various reasons. The specific indications include:

Malfunction of Existing Device Replacement is necessary when the current implant is not functioning properly, which may affect the patient's hearing capabilities.
Healthy Mastoid Condition The procedure is performed when the mastoid is healthy, ensuring that there are no underlying infections that could complicate the surgery.
Hearing Loss Not Due to Chronic Infection The procedure is suitable for patients whose hearing loss is not a result of chronic infections, allowing for effective use of the bone conduction implant.

2. Procedure

The procedure for CPT® Code 69719 involves several detailed steps to ensure the successful replacement of the osseointegrated implant:

Site Preparation The surgical site is planned to be approximately 5.5 cm behind the ear canal, at a height that aligns with the top of the auricle. Hair is removed from the area to maintain a sterile environment, and the planned implant site is measured and marked accurately.
Incision and Dissection An incision is made at the marked site, followed by careful dissection down to the subpericranium. This meticulous approach is essential for the safe removal of the existing implant.
Inspection of Wound The surgical site is inspected for any complications that may have arisen from the previous implant, ensuring that any issues are addressed before proceeding.
Creation of Subpericranial Pocket A subpericranial pocket is created for the new implant coil and magnet, which is crucial for the proper placement of the new device.
Transducer Site Identification The transducer site is identified using a template, and the location is marked on the outer skull to ensure accurate placement of the new implant.
Drilling Fixation Holes Fixation holes are drilled into the skull, taking care to avoid the sigmoid sinus and dura mater over the temporal lobe, which are critical structures that must remain intact.
Measurement and Drilling of Skull The depth of the site is measured to accommodate the fixation screw, and the skull is drilled to create a well that is less than 100 sq mm in surface area beyond the outer cortex for the transducer.
Placement of Implant Components The coil, magnet, and transducer components are placed into the well, and the entire device is fixed to the skull using a fixation screw, which is set to a specific torque value to ensure stability.
Skin Flap Adjustment The thickness of the skin flap over the magnet and coil is measured and carefully reduced to an optimal thickness for effective transcutaneous transmission of sound.
Integration with Tissue Over the following months, the implant will merge with the living tissue, providing a stable and functional connection for the patient.

3. Post-Procedure

After the procedure, patients can expect a recovery period during which the surgical site will heal. The external speech processor can be attached and detached from the implant via the magnet, allowing for flexibility in use. Patients should be monitored for any signs of complications or infection at the surgical site. The integration of the implant with living tissue will occur over several months, during which time the patient may gradually experience improved auditory function as the device becomes fully operational.

Short Descr	RPLCM OI IMPLT SK TC ESP<100
Medium Descr	RPLCMT OI IMPLT SKULL MAG TC ATTACHMENT ESP<100
Long Descr	Replacement (including removal of existing device), osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, within the mastoid and/or involving a bony defect less than 100 sq mm surface area of bone deep to the outer cranial cortex
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)	none
MUE	1

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).
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.
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)
RT	Right side (used to identify procedures performed on the right side of the body)