CPT 69960 (Release Inner Ear Canal) is NOT Medically Necessary for Lumbar Fusion Surgery
CPT code 69960 (release of inner ear canal) has no clinical indication or relevance to lumbar spine fusion surgery and should be denied as not medically necessary. 1
Rationale for Denial
CPT 69960 is an otolaryngologic procedure specifically designated for inner ear canal release, which is completely unrelated to the treatment of lumbar degenerative disc disease, radiculopathy, or spinal stenosis 1
The patient's clinical presentation involves lumbar pathology including L4-5 disc extrusion with left lateral recess stenosis and L5-S1 right paracentral disc bulge with foraminal stenosis—none of which require or benefit from inner ear canal procedures 1
There is no anatomic, physiologic, or clinical connection between inner ear canal procedures and the surgical management of lumbar spine pathology 1
Assessment of the Appropriate Lumbar Procedures
While the inner ear procedure is not indicated, the requested lumbar fusion procedures (22558,22585,22853,22845,20930,76000) appear appropriate based on the following:
Patient Meets Criteria for Lumbar Fusion
Failed comprehensive conservative management including medications, injections, physical therapy, and activity modification over an adequate timeframe 2, 1
Documented anatomic pathology with positive discography at L4-5 correlating with clinical symptoms and MRI findings showing disc extrusion and stenosis 2, 1
Previous failed surgical intervention (L5-S1 microdiscectomy) with recurrent symptoms, which represents Level II evidence supporting fusion over repeat decompression alone 1
Persistent radiculopathy with objective findings including right dorsiflexion weakness and bilateral lower extremity radiation 1
Evidence Supporting Fusion for This Clinical Scenario
Level II evidence supports lumbar fusion over traditional physical therapy in patients with chronic discogenic low back pain who have failed conservative management 2
Positive discography at L4-5 with concordant pain provides diagnostic confirmation of discogenic pain source, supporting fusion as the appropriate intervention 2, 1
Post-laminectomy syndrome with recurrent stenosis demonstrates Class II medical evidence supporting fusion following decompression in patients with lumbar stenosis 1
Common Pitfall to Avoid
Bundling unrelated procedures with spine surgery is inappropriate and represents either a coding error or an attempt to bill for services that have no medical necessity for the patient's condition 1
The requesting provider should be contacted to clarify whether CPT 69960 was included in error, as there is no conceivable clinical scenario where inner ear canal release would be performed during lumbar fusion surgery