CPT® Code 69729

Official Description

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

Common Language Description

The procedure described by CPT® Code 69729 involves the implantation of an osseointegrated implant in the skull, specifically designed for patients requiring a bone conduction implant (BCI) system. This system utilizes an external hearing aid or speech processor that amplifies sound, which is then transmitted through the implant anchored to the skull. The sound vibrations are conducted via the bone directly to the cochlea, facilitating improved auditory perception for individuals with certain types of hearing loss. The unique aspect of this procedure is the use of a magnetic transcutaneous attachment to the external speech processor, which is positioned outside of the mastoid area. This approach is particularly beneficial for patients with compromised mastoid health, such as those suffering from chronic infections that may affect the ear's anatomy and function. The surgical intervention is meticulously planned, typically occurring in the retrosigmoid area or the squamous part of the temporal bone, behind the ear. The procedure requires careful preparation, including the removal of hair from the surgical site, precise measurement, and marking of the implant location. The surgical technique involves creating a subpericranial pocket for the implant components, ensuring that the integrity of surrounding structures, such as the sigmoid sinus and dura mater, is maintained. The procedure necessitates the removal of a significant surface area of bone, specifically greater than or equal to 100 square millimeters, to accommodate the implant and ensure proper integration with the living tissue over time. This careful approach not only enhances the effectiveness of the implant but also minimizes potential complications associated with the surgery.

1. Indications

The procedure described by CPT® Code 69729 is indicated for patients who require a bone conduction implant (BCI) system due to specific conditions affecting their auditory function. The following indications are explicitly recognized for this procedure:

Chronic Ear Infections Patients with chronic infections that compromise the mastoid area may benefit from this procedure, as it allows for sound transmission without relying on the compromised structures.
Conductive Hearing Loss Individuals experiencing conductive hearing loss, where sound is not effectively conducted through the outer or middle ear, may find this procedure advantageous.
Unilateral Hearing Loss Patients with unilateral hearing loss, where hearing is significantly impaired in one ear, can utilize this implant to improve auditory perception on the affected side.
Congenital Ear Malformations Those born with malformations of the ear that hinder normal hearing may also be candidates for this surgical intervention.

2. Procedure

The procedure for CPT® Code 69729 involves several critical steps to ensure successful implantation of the osseointegrated device:

Step 1: Surgical Site Preparation The surgical site is prepared by removing hair from behind the ear, allowing for a clear view and access to the area where the implant will be placed. The planned implant site is then measured and marked accurately to ensure proper placement of the device.
Step 2: Incision and Dissection An incision is made at the marked site, followed by careful dissection to create a subpericranial pocket. This pocket is essential for housing the implant coil and magnet, ensuring that they are positioned correctly beneath the skin.
Step 3: Identification of Transducer Site The transducer site on the skull is identified and marked. This step is crucial for ensuring that the implant is placed in the optimal location for effective sound transmission.
Step 4: Drilling Fixation Holes Fixation holes are drilled into the skull, taking great care to avoid damaging the sigmoid sinus and dura mater, which are critical structures located in the vicinity. This step requires precision to prevent complications during the procedure.
Step 5: Bone Removal The surgeon drills into the skull to remove greater than or equal to 100 square millimeters of bone surface area, creating a well that accommodates the transducer. This step is performed with caution to ensure that the dura mater and sigmoid sinus are not injured, and to avoid any damage to the facial nerve and large blood vessels.
Step 6: Placement of Implant Components Once the well is created, the coil, magnet, and transducer components are placed into the prepared site. The entire device is then fixed to the skull using a fixation screw, which is set to a specific torque to ensure stability.
Step 7: Skin Flap Adjustment The thickness of the skin flap over the magnet and coil is measured and carefully reduced to an optimal thickness for transcutaneous sound transmission, ensuring that the external processor can effectively communicate with the implant.
Step 8: Wound Closure The surgical site is irrigated to prevent infection, and the incision is closed in layers to promote proper healing and minimize scarring.

3. Post-Procedure

After the procedure, patients can expect a recovery period during which the implant will begin to integrate with the living tissue. This osseointegration process typically takes several months, during which the implant becomes securely anchored to the bone. Post-operative care may include monitoring for signs of infection, managing pain, and following up with the healthcare provider to assess the healing process. Patients will also receive instructions on how to care for the surgical site and when to resume normal activities. It is essential for patients to adhere to these guidelines to ensure optimal outcomes and the successful functioning of the bone conduction implant.

Short Descr	IMPL OI IMPLT SK TC ESP>=100
Medium Descr	IMPL OI IMPLT SKULL MAG TC ATTACHMENT ESP>=100
Long Descr	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
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).
78	Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
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)