Is a release of the inner ear canal (procedure 69960) medically necessary for a patient with chronic low back pain undergoing L4-5 and L5-S1 spinal fusion?

No, CPT 69960 (Release of Inner Ear Canal) is NOT Medically Necessary for Lumbar Fusion Surgery

CPT code 69960 is an otologic (ear) procedure that has absolutely no relationship to lumbar spinal fusion surgery and should be denied as not medically necessary for this indication. 1

Critical Issue: Wrong Anatomical System

• CPT 69960 is specifically for decompression of the internal auditory canal, a procedure performed by otolaryngologists or neurotologists for conditions affecting the inner ear and auditory nerve 1
• The patient's clinical presentation involves lumbar degenerative disc disease with radiculopathy—a spinal condition with no connection to the auditory system 1
• This appears to be a coding or documentation error, as none of the requested spinal procedures (22558,22585,22853,22845,20930,76000) involve ear canal structures 1

Medical Necessity for the Lumbar Fusion Procedures

The Spinal Fusion IS Medically Necessary

The patient meets established criteria for L4-5 and L5-S1 lumbar fusion based on:

• Failed comprehensive conservative management including medications, injections, physical therapy, and activity modification 1
• Previous L5-S1 microdiscectomy with recurrent symptoms, indicating post-laminectomy syndrome with potential instability 1
• Positive discography at L4-5 correlating with clinical symptoms 2, 1
• Documented anatomical pathology including L4-5 disc extrusion with lateral recess stenosis and L5-S1 disc bulge with foraminal stenosis causing radiculopathy 1
• Objective neurological findings with right dorsiflexion weakness 1

Evidence Supporting Fusion in This Clinical Context

• Level II evidence supports lumbar fusion over conservative management alone in patients with chronic discogenic low back pain who have completed appropriate conservative therapy 2
• Fusion following previous decompression (post-laminectomy syndrome) has Class II medical evidence supporting its use, with fusion rates of 92-95% 1
• The combination of radiculopathy, positive discography, and failed prior surgery represents appropriate indications per neurosurgical guidelines 1

Approved Procedures for This Patient

The following CPT codes ARE medically necessary:

• 22558 (Lumbar arthrodesis, anterior interbody technique) - appropriate for addressing disc pathology 1
• 22585 (Arthrodesis, additional interspace) - justified for two-level fusion 1
• 22853 (Insertion of biomechanical device) - necessary for interbody cage placement 1
• 22845 (Instrumentation, posterior segmental) - provides stability with pedicle screw fixation achieving 95% fusion rates 1
• 20930 (Allograft, structural) - appropriate bone graft material 1
• 76000 (Fluoroscopy) - standard intraoperative imaging 1

Common Pitfall Identified

• This case represents a clear coding error where an otologic procedure code was mistakenly included in a spinal surgery authorization request 1
• Ensure all CPT codes match the anatomical region and surgical indication being treated 1
• The ear canal procedure should be removed from the authorization request entirely 1