Revenue Cycle Insider

Question: I could use some help in billing for cochlear implants, specifically what a complete surgical claim should include. We are currently using 69930 for the surgery along with L8614 for the device. Are there additional codes that I should be using in conjunction with these codes? The codes that my physician would like to use are:

• 69930
• 69502
• 69440
• +69990

But I am pretty sure 69502, 69440, and +69990 are bundled into 69930. Who is right?

AAPC Forum Participant

Answer: You are correct in using 69930 (Cochlear device implantation, with or without mastoidectomy) with L8614 (Cochlear device, includes all internal and external components) to describe cochlear implantations. And you are also correct in saying you cannot use any of the other codes as they are essentially bundled into the 69930 procedure when performed on the same ear on the same patient on the same date of service (DOS).

Here’s why:

• As the descriptor for 69930 states, a cochlear implant includes 69502 (Mastoidectomy; complete) when performed.
• The procedure described in 69440 (Middle ear exploration through postauricular or ear canal incision) is considered integral to the surgical approach for 69930.
• The procedure described in +69990 (Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure)) is also considered integral to 69930, as an operating microscope is the standard tool surgeons use for the procedure.

NCCI alert: Be aware that payer policies, such as the Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits, can be confusing on these bundlings. For example, CMS has understandably assigned a modifier indicator of “0” to 69930 and +69990 when 69930 is the column 1 code, meaning that Medicare will only pay for 69930 for the same patient on the same DOS, and no NCCI-associated modifier can override the edit.

However, CMS has also assigned a modifier indicator of “1” to the 69930 and 69502 edit pair, meaning that they will pay for 69502 when you append an appropriate NCCI-associated modifier. And 69440 is not a column 2 code to 69930, so CMS will pay for the column 2 code without a modifier for the same patient on the same DOS. This means you should be sure to check payer policies before billing either procedure with 69930, and make sure your documentation shows medical necessity for your surgeon performing either procedure with 69930.

Don’t forget: Payers regard cochlear implantations as unilateral, which provides some of the rationale behind CMS’ bundling policies, as a surgeon could theoretically implant a cochlear device in one ear while performing a mastoidectomy or a middle ear exploration on the other for the same patient on the same DOS. However, if your surgeon implants cochlear devices in both ears, you may have to append modifier 50 (Bilateral procedure) on one line, or modifiers LT (Left side) and RT (Right side) on two lines, of your bill depending on payer preference. And remember: CMS’ bilateral surgery rules pay the first surgery at 100 percent and the second surgery at 50 percent.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC