Autologous Soft Tissue Grafting (CPT 15769) is NOT Medically Necessary During Standard Cochlear Implant Procedures
Code 15769 for autologous soft tissue grafting should be denied for this cochlear implant procedure, as there is no documented clinical indication requiring skin or tissue grafting based on the patient's presentation and surgical findings. 1
Rationale for Denial
Standard Cochlear Implant Procedure Does Not Require Grafting
The American Academy of Otolaryngology guidelines explicitly do not recommend routine soft tissue grafting during primary cochlear implant procedures, as the standard technique does not require it for typical cases 1
This patient presents with straightforward anatomy: normal inner ears on CT scan, intact cochlear nerves, and no structural abnormalities that would necessitate tissue grafting 1
The classical cochlear implant technique (code 69930) involves mastoidectomy and posterior tympanotomy but does not routinely require soft tissue grafting 2
Specific Indications for Code 15769 Are Absent
The MCG criteria for code 15769 require documentation of:
- Large wounds or ulcers, OR
- Reconstructive surgery necessitating tissue transfer [@case documentation@]
Neither condition is present in this case:
- No preoperative skin defects, wounds, or ulcers are documented [@case documentation@]
- No intraoperative complications requiring reconstruction are noted [@case documentation@]
- The patient has normal facial anatomy with contracted mastoids and anterior sigmoid on the left—anatomic variants that do not require grafting [@case documentation@]
Evidence-Based Complication Rates Support Non-Use
Cochlear implantation without routine soft tissue grafting has documented complication rates of only 8.86%, demonstrating safety without this additional procedure 1
The American Academy of Otolaryngology guidelines for cochlear implantation contain no documented evidence supporting routine soft tissue grafting during primary procedures 1
When Grafting IS Indicated (Not Applicable Here)
Autologous soft tissue grafting in cochlear implant surgery is reserved for specific salvage situations:
- Skin necrosis or pressure injuries threatening implant extrusion in existing implant recipients 3, 4
- Revision surgery with extensive tissue resection due to infection requiring implant site relocation 3
- Full-thickness skin defects encountered during implant replacement 3
- Fat grafting for impending extrusion in patients with severe skin thinning over the receiver/stimulator 4
None of these scenarios apply to this primary implant candidate with normal skin and tissue integrity.
Clinical Pitfall to Avoid
Do not conflate the potential need for mastoidectomy modifications with tissue grafting requirements. While this patient has contracted mastoids and anterior sigmoid sinus (anatomic variants that may affect surgical approach), these findings do not create a need for soft tissue grafting 2, 5. The surgeon may need to modify technique or avoid mastoidectomy entirely, but this is a surgical approach decision, not an indication for code 15769 2.
Appropriate Billable Codes for This Case
The following codes are medically necessary and supported:
- 69930: Cochlear device implantation (primary procedure) [@case documentation@]
- L8614: Cochlear device with all components [@case documentation@]
- 69990: Microsurgical techniques (add-on code) [@case documentation@]