Tag Archives: bone anchored hearing system

The Holger’s Scale vs the IPS-Score

A Review of Percutaneous Implant Complication Scores for Audiologists

What is the Holger’s Scale?

The Holger’s Scale was created as a measure of the clinical status of soft tissue surrounding a titanium implant, such as the Ponto™ System. Its goal was to evaluate the frequency and magnitude of adverse reactions more effectively in this population in future research.1

How was it developed?

The foundation of the Holger’s Scale was a comprehensive study that examined 60 patients who received 67 abutments/implants. Patients were followed for periods ranging from three to 96 months. Over this period, only one implant was removed for reasons associated with skin complications.1

Why is this relevant for audiologists?

The Holger’s Scale is a simple tool that clinicians can use to record any adverse skin reactions ranging from swelling and redness to skin overgrowth and implant removal. Additionally, this measure is often utilized in research regarding percutaneous implants.1

Where do most patients lie on the Holger’s scale post-Ponto implantation?

Studies show that Ponto implant patients, when undergoing the MIPS or MONO procedures, typically have minimal skin-related complications as noted by a Holgers Score of ≤2.2,3 Remarkably, 97 percent of patients exhibit no or minor skin reactions post-operatively.

Are there any limitations to the Holger’s Scale?

Kruyt et al. (2017) suggest several limitations to the Holger’s Scale despite its simplicity and usability.4 These include:

  • The scale can be used to indicate treatment, but these decisions are not standardized.
  • The scale was designed to evaluate skin reactions three months post-operatively, and thus cannot evaluate complications in healing.
  • The scale does not evaluate any pain reported by the patient.
  • Skin height, in regards primarily to skin overgrowth, is not noted in the original Holger’s scale. Often, skin overgrowth can lead to abutment changes or revision surgery.

Additionally, it does not describe possible complications of transcutaneous implants. Due to these limitations, a new scale, the IPS-Scale, was developed to evaluate complications related to percutaneous and transcutaneous implants.4

In response to these limitations, the IPS-Scale was developed to provide a more comprehensive evaluation of complications related to both percutaneous and transcutaneous implants. The IPS-Scale differentiates between the two types of implants and assigns scores for specific categories, such as inflammation, pain, and skin height (for percutaneous implants) or skin numbness (for transcutaneous implants). These individual scores are then combined to generate the IPS-Score, offering a more nuanced guide for treatment selection.

The three scores are then combined to generate the IPS-Score, which then can be used to guide treatment selection.4

No matter which scale you utilize, Ponto implantation patients experience minimal complications post-operatively, and thus benefit from excellent skin outcomes, favorable aesthetic results, and fast recovery times with few complications.5,6

References

  1. Holgers KM, Tjellstrom A, Bjursten LM, Erlandsson BE. Soft tissue reactions around percutaneous implants: a clinical study on skin-penetrating titanium implants used for bone-anchored auricular prostheses. Int J Oral Maxillofac Implants. 1987 Winter;2(1):35-9. PMID: 3471713.
  2. Holmes, S., Hamiter, M., Berry, C., & Mankekar, G. (2021). Tissue preservation techniques for bone-anchored hearing aid surgery. Otology & Neurotology42(7), 1044-1050.
  3. Data on file at Oticon Medical, Clinical study BC108
  4. Kruyt, I.J., Nelissen, R.C., Johansson, M.L., Mylanus, E.A.M. and Hol, M.K.S. (2017), The IPS-scale: A new soft tissue assessment scale for percutaneous and transcutaneous implants for bone conduction devices. Clin Otolaryngol, 42: 1410-1413. https://doi.org/10.1111/coa.12922
  5. Oticon Medical Whitepaper – The MONO procedure
  6. Lagerkvist H, Carvalho K, Holmberg M, Petersson U, Cremers C, Hultcrantz M. Ten years of experience with the Ponto bone-anchored hearing system—A systematic literature review. Clin Otolaryngol. 2020; 45: 667–680. https://doi.org/10.1111/coa.13556
Female audiologist with female patient

Medicare Updates and Audiology Changes for 2024

New Bone Anchored Codes and Payment Adjustments

Key Takeaways:

  • Starting January 1, 2024, audiologists will be able to bill for diagnostic analysis, programming, and verification of auditory osseointegrated devices (92622 & 92623)
  • The codes are timed codes with 92622 representing the first hour of service and 92623 serving as additional 15-minute increments
  • The CMS has lowered their conversion factor to $32.74, making the reimbursement for 92622 & 92623 $77.59* and $19.97* respectively

 The Centers for Medicare & Medicaid Services (CMS) has proposed significant changes for audiology services in 2024. Audiologists will see the introduction of two new timed codes effective January 1, 2024, which describe the analysis, programming, and verification of an auditory osseointegrated sound processor like the Ponto bone anchored hearing system (BAHS). Additionally, the CMS has proposed payment adjustments and continued telehealth coverage. Let’s dive into the details.

New Auditory Osseointegrated Device (AOD) Services Codes

Starting from January 1, 2024, audiologists will be able to use two new CPT codes for Auditory Osseointegrated Device (AOD) services. These codes are designed to cover the diagnostic analysis, programming, and verification of an auditory osseointegrated sound processor:

  • 92622: Diagnostic analysis, programming, and verification of an auditory osseointegrated sound processor, any type; first 60 minutes.
  • 92623: Diagnostic analysis, programming, and verification of an auditory osseointegrated sound processor, any type; each additional 15 minutes (use 92623 in conjunction with 92622).

A keynote is that these codes are applicable to audiologists without a physician’s referral for a non-acute hearing condition. Furthermore, they include tasks such as attachment of the processor, device feedback calibration, device programming, and verification of processor performance for various types of auditory osseointegrated sound processors.

Important Points about AOD Services

  • Timed Codes: The new codes, 92622 and 92623, are timed codes that describe the first hour and each subsequent 15 minutes of time spent on the analysis, programming, and verification of an auditory osseointegrated sound processor.

If an evaluation lasts less than 30-minutes, 92623 (code indicating additional 15 minutes) should not be billed independently from 92622. Additionally, the -52 modifier should also not be used with 92622 or 92623 in this case. Instead, 92700 (unlisted Otorhinolaryngological Service or Procedures) can be used with the proper documentation and justification.

  • Reprogramming: These codes may also be used for reporting subsequent reprogramming of AODs.
  • Restrictions: Notably, CPT codes 92626 and 92627 may not be reported in conjunction with 92622 and 92623.

Medicare Physician Fee Schedule (PFS) Changes and Reimbursement

CMS has adjusted the Medicare Physician Fee Schedule (PFS) for the calendar year 2024. Key highlights include an overall payment rate reduction of 1.25 percent in calendar year (CY) 2024 compared to CY 2023. The final CY 2024 PFS conversion factor is $32.74, representing a decrease of $1.15 (or 3.4 percent) from the CY 2023 conversion factor of $33.89.

*According to the American Academy of Audiology, the “CY 2024 Final Payment” for non-facilities for the new service codes will be as follows. Note final reimbursement is dependent on your locality:

  • 92622 –  $77.59
  • 92623 – $19.97

Click the links below for more information regarding these important changes:

Microsoft Word – Audiology MPFS Final CY 2024.Table.docx

Medicare Proposes New Codes and Reporting Measures, Payment Cuts, and Continued Telehealth Coverage for 2024 (asha.org)

Calendar Year (CY) 2024 Medicare Physician Fee Schedule Proposed Rule | CMS

Medicare Finalizes CY 2024 Payment Rules – American Academy of Audiology

*Content updated 3/26/24

Presidential Perspective

Joys and Challenge of Overseeing a Business in Growth Mode

As I write this, I am overseeing the largest expansion of Oticon Medical US in our history. As you can imagine, this comes with its shares of joys and challenges as we blaze our way toward an exciting new future.

So, what’s going on? To start with, we are juggling three major overlapping product launches. One I’ve already shared—the premarket approval of cochlear implant sales in the US. The second, which I’m excited to share with you now, is the launch of the first style in our new family of bone anchored hearing systems, the Ponto™ 5 Mini (you’ll have to wait a bit more to hear about the third launch, but I promise you’re going to like it).

Introducing the Ponto 5 family of bone conduction hearing devices

If you haven’t read our press release yet, here is a rundown of what the Ponto 5 Mini has to offer. While it remains the world’s smallest and most discreet processor on the market, it also offers the same state-of-the-art reliability, durability, connectivity, and product quality our customers came to know and expect from Ponto 4. Additionally, Ponto 5 utilizes two of our proven BrainHearing™ technologies, the OpenSound Navigator™ and OpenSound Optimizer™ to provide wearers with greater access to sound than ever before. We confirmed this in a study that shows that these technologies improve speech understanding by 20 percent* and significantly reduce the listening effort needed to make sense of sound.[1] While traditional feedback systems have previously addressed feedback by reducing gain and removing the dynamics of sound, the OpenSound Optimizer analyzes amplified sound 56,000 times per second to detect and actually prevent audible feedback before it occurs.[2] Hearing care professionals no longer need to compromise on sound dynamics to reduce feedback and can fit Ponto 5 Mini wearers with up to 6 decibels (dB) more stable gain.

Raise your level of patient care with RemoteCare

Another unique feature of the Ponto 5 Mini is the introduction of the user-friendly Oticon RemoteCare platform, which allows wearers to have follow-up appointments and adjustments made remotely. Now, I know when audiology professionals see the words “remote care,” you might become worried that it means you will be expected to be on call 24/7. I want to assure you this is not the case at all! You will remain in full control of your schedule and appointments just as you do when arranging appointments with patients face-to-face. RemoteCare simply allows you to reduce the number of office visits for issues that can be easily remedied remotely, such as making tweaks to programs. The RemoteCare option is extremely beneficial for patients who either live far from your office, have busy schedules that make it hard for them to travel, or are too infirm to attend in-office appointments. And with ongoing concerns about Covid-19, it enables you to treat patients who otherwise might not feel comfortable meeting with you directly—and vice-versa depending on your personal health concerns.

I hope you’re enjoying the journey with us as we continue to expand our product and service offerings to you and your patients. For more information anytime, please contact your local Oticon Medical representative. In the meantime, I encourage you to keep an eye on our social media properties and share all the latest news with your own patient base through your Facebook, Twitter, LinkedIn, and other communications outlets. Oticon Medical’s rising tide is intended to lift all boats, so join us and enjoy the ride!

[1] Manuscript in preparation, Data on File - Clinical study BC102
[2] Data on file at Oticon Medical
*Increased speech understanding with OpenSound Navigator ON measured as a percentage relative to the baseline with OpenSound Navigator OFF.