CPT® Code 69728

Official Description

Removal, entire osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, outside the mastoid and involving a bony defect greater than or equal to 100 sq mm surface area of bone deep to the outer cranial cortex

Common Language Description

The procedure described by CPT® Code 69728 involves the complete removal of an entire osseointegrated implant from the skull, specifically one that features a magnetic transcutaneous attachment to an external speech processor. This type of implant is designed to facilitate bone conduction of sound, allowing sound vibrations to be transmitted through the bone to the cochlea, thereby aiding individuals with hearing loss. The external speech processor, which is magnetically attached to the implant, is situated beneath a thin layer of skin, making it a minimally invasive option for sound amplification. The removal of such an implant may be necessitated by various factors, including persistent pain, infection, instability of the implant, trauma, or failure of the implant to properly integrate with the bone (osseointegration). The procedure is typically performed in the area behind the ear, specifically within the mastoid region or the retrosigmoid area, and involves careful surgical techniques to ensure the surrounding tissues are preserved while effectively removing the implant. This procedure is particularly complex due to the involvement of a bony defect that is greater than or equal to 100 square millimeters in surface area, which requires meticulous attention to detail during the surgical process.

1. Indications

The procedure described by CPT® Code 69728 is indicated for the complete removal of an osseointegrated implant from the skull in the following circumstances:

Pain Persistent discomfort or pain associated with the implant that may not respond to conservative management.
Infection Presence of infection around the implant site that could compromise the integrity of the surrounding tissues or the implant itself.
Implant Instability Situations where the implant has become unstable, leading to inadequate function or discomfort for the patient.
Trauma Any trauma to the implant that may have caused damage or displacement, necessitating removal.
Failure to Osseointegrate Instances where the implant has failed to properly integrate with the bone, resulting in a lack of stability and function.

2. Procedure

The procedure for the removal of the osseointegrated implant involves several critical steps to ensure a safe and effective outcome:

Step 1: Identification and Preparation The surgical site is first identified, typically located in the bone behind the ear within the mastoid region. The area is prepared for surgery, and local anesthesia is administered to minimize discomfort during the procedure.
Step 2: Incision and Flap Creation The skin overlying the implant is carefully measured and marked. An incision is made to create skin and periosteal flaps, allowing access to the underlying tissues and the implant.
Step 3: Incision of Subcutaneous Tissue The subcutaneous tissue surrounding the implant is incised to expose the implant and the surrounding bone. This step is crucial for accessing the implant securely.
Step 4: Drilling and Removal The bone is drilled out around the implant to free it from its bed. This requires precision to avoid damaging surrounding structures. Once adequately loosened, the existing implant is carefully removed.
Step 5: Investigation and Cleansing After the implant is removed, the cause of any complications is investigated. The wound site is thoroughly cleansed and irrigated to prevent infection and promote healing.
Step 6: Closure Finally, the surrounding soft tissues are closed over the wound, ensuring proper healing and minimizing scarring.

3. Post-Procedure

Post-procedure care following the removal of the osseointegrated implant is essential for recovery. Patients are typically monitored for any signs of infection or complications at the surgical site. Pain management may be provided as needed, and instructions regarding wound care will be given to ensure proper healing. Follow-up appointments are crucial to assess the healing process and to determine if any further interventions are necessary. Patients may also be advised on the potential need for alternative hearing solutions, depending on their individual circumstances and the reason for the implant removal.

Short Descr	RMV NTR OI IMP SK TC>=100
Medium Descr	RMVL ENTIRE OI IMPLT SKL MAG TC ATTCH ESP>=100
Long Descr	Removal, entire osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, outside the mastoid and involving a bony defect greater than or equal to 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	Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight.
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	none
MUE	1

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).
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).
LT	Left side (used to identify procedures performed on the left side of the body)