Otolaryngology Coding Alert

The October 2009 Otolaryngology Coding Alert article on the bone anchored hearing aid (BAHA) system contained errors. Here is the correct information:

Correction 1: The FDA lists the following criteria for BAHA use in single-sided deafness:

• Greater than or equal to 5 years of age;

• Normal hearing in contralateral ear. Normal hearing is defined as a pure tone average for air conduction thresholds equal to or better than 20dB HTL at .5, 1, 2, 3kHz;

• Functions by transcranial routing of signal.

Correction 2: BAHA is considered a special application of mastoidectomy. The most common reason you do a mastoidectomy is to remove a disease of the mastoid itself due to mastoiditis (383.xx) or cholesteatoma (385.xx).

Just the same, your physician could also use it as an approach to other structures in the ear. For example, the BAHA system and cochlear implants are inserted into the inner ear after performing a mastoidectomy. The mastoidectomy allows the surgeon to insert the BAHA/implant into the inner ear at the proper angle and with good visualization.

Correction 3: The most common reason in adults for BAHA revision is skin thickening. You would possibly code 69711 (Removal or repair of electromagnetic bone conduction hearing in temporal bone) in this case, if one only thinned around the BAHA, says Loren Bartels, MD, FACS, director of the Tampa Bay Hearing and Balance Center and clinical professor of otolaryngology at University of South Florida College of Medicine in Tampa, Fla.

"It is clear that the 69714 (Implantation, osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; without mastoidectomy) description includes only a portion of such a revised surgical procedure. Since the code came out in 2001, the surgical management of BAHA has changed to include a broad scalp flap which is circumferential. The latter was intended to reduce the need for revisions," Bartels says.

In children, the most common reason is loosening of the screw with consequent loss. That means you'll most likely report the replacement code (69717, Replacement [including removal of existing device], osseointegrated implant, temporal bone, with percutaneous attachment to external speech processor/cochlear stimulator; without mastoidectomy).

Correction 4: Physicians and medical practices never test BAHA in surgery. The device is simply a machined screw. It is not a testable piece of electronic equipment. There is no specific testing equipment, therefore no standard of care for such, Bartels says.