AN2114

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The doctor removed and implanted a cochlear implant. I originally thought I would use cpt code 69710 or 69717 but I read that 69930 includes the removal so I just want to make sure which cpt code would be best to use. Here is the report:

Procedure: Right revision cochlear implant

Details:
After consent was obtained in the preoperative suite, the patient was taken back to the operative suite, laid in supine position on the table. Anesthesia was induced. The patient was restrained with multiple straps. The time out was performed and all in attendance were in accordance. The patient was hooked to a facial nerve monitor on the right side, this was tested with a tap test and appeared to be in good working order. Then 0.5% lidocaine with 1:200,000 epinephrine was injected over the planned incision site postauricularly, a total of 1 mL was injected. Then the patient was prepped and draped in normal sterile fashion for a cochlear implant. Then a postauricular incision was performed and extended superiorly and posteriorly along the previous incision line. Then this was carried down through to the periosteum. The periosteum was elevated using a Lempert elevator and a Freer elevator, up to the external auditory canal. The drilled mastoid cavity was viewed with some bony overgrowth. Therefore, the Weitlaner retractors were used to hold the soft tissues out of the way while a #4 cutting bur was used to remove the bony overgrowth over the mastoid bowl and come back down the posterior wall of the canal. We then switched to a #2 diamond bur to continue within the medial aspect of the canal wall. The previously placed implant was visualized and the scar tissue near the round window was removed. Then the new implant was placed in the subperiosteal plane, superiorly to the auricle, and posterior superior and posterior to the auricle. Then, the ground electrode was sank subperiosteally, superior to the auricle and the previously placed right cochlear implant was removed and the 612 cochlear implant was placed through the round window and advanced to its hub. The stylet was removed. Audiology was brought in to the room, the patient's NRTs were checked, and the implant appeared to be functioning in good working order. The patient's tissues were reapproximated using a 4-0 Vicryl suture to reapproximate the periosteum and muscle layers. Then a 4-0 Vicryl suture was used to reapproximate the dermal layer. Then 5-0 fast-absorbing gut suture was used to reapproximate the sueperficial skin. Mastisol, steris were placed over the wound to relieve additional tension. Then a mastoid dressing was applied. The patient was turned back over to anesthesia in good condition. There were no complications, and the patient tolerated the procedure very well. They will be sen back to the post-anesthesia care unit. IF they are doing well, they will be sent to the floor and held overnight for observation. If no hematoma collection, they will be sent home tomorrow, barring any complications.
 
Manders21, I am not an expert in cochlear implants, but I can tell you this:
69710 is a BAHA, (Bone Anchored Hearing Aid) not a cochlear
69717 includes: "with percutaneous attachment to external speech processor/cochlear stimulator;" and that was not included in your note.

I think 69930 is the proper code to use. If the removal of the existing implant created extensive difficulty, I would add a 22 modifier for increased service, but based on the op note you provided, I do not see that extensive difficulty and therefore do not feel that the 22 modifier is justified.
 
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