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Official Description

Radical excision external auditory canal lesion; with neck dissection

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 69155 involves a radical excision of a lesion located in the external auditory canal, accompanied by a neck dissection. This surgical intervention is necessary when a lesion has begun to invade surrounding structures, necessitating the removal of not only the lesion itself but also a margin of healthy tissue to ensure complete excision. The procedure is performed with careful consideration to protect the facial nerve, which is critical for facial movement and expression. An incision is typically made in the external auditory canal, extending towards the front of the ear and into the parotid gland area. The excision includes the anterior portion of the lesion along with parts of the parotid gland, and may also involve a post-auricular incision to facilitate the removal of the tumor and any affected surrounding tissues, including the canal wall, external ear cartilage, and potentially bone. During the surgery, intraoperative frozen sections of the surgical margins are analyzed pathologically to check for tumor invasion. If any margins are found to be positive for tumor, additional piecemeal resection is performed to ensure that all visible and microscopic tumor evidence is eliminated. The procedure may also involve the removal of skin, soft tissue, cartilage, and bone as necessary. If reconstruction of the external auditory canal is required, this can be reported separately, particularly if skin grafts are utilized. It is important to note that CPT® Code 69150 is applicable when a radical excision is performed without a radical neck dissection, while CPT® Code 69155 is specifically used when a radical neck dissection is included in the procedure.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The radical excision of an external auditory canal lesion with neck dissection, as described by CPT® Code 69155, is indicated for patients presenting with lesions that have begun to invade adjacent structures. This procedure is typically performed in cases where there is a concern for malignancy or significant tumor growth that necessitates extensive removal to prevent further spread or complications.

  • Lesion Invasion The procedure is indicated when a lesion in the external auditory canal shows signs of invading surrounding tissues, which may include the parotid gland and adjacent anatomical structures.
  • Malignancy Concern It is performed when there is a suspicion or diagnosis of malignancy, requiring comprehensive excision to ensure complete removal of cancerous cells.
  • Pathological Findings The need for this procedure may arise from pathological findings that indicate tumor invasion beyond the initial lesion site, necessitating a more radical approach.

2. Procedure

The procedure for CPT® Code 69155 involves several critical steps to ensure the complete excision of the lesion and any affected surrounding tissues.

  • Step 1: Incision The surgeon begins by making an incision in the external auditory canal, which extends towards the front of the ear and into the parotid gland area. This incision is designed to provide access to the lesion while minimizing damage to surrounding structures, particularly the facial nerve.
  • Step 2: Lesion Excision The anterior portion of the external auditory canal lesion is excised, along with portions of the parotid gland. This step is crucial for removing the tumor and any potentially affected tissue.
  • Step 3: Additional Incision A post-auricular incision may be made to facilitate the removal of the tumor around its base. This incision allows for the excision of the canal wall, external ear cartilage, and any other affected tissue, ensuring a comprehensive approach to tumor removal.
  • Step 4: Intraoperative Pathological Examination During the procedure, intraoperative frozen sections of the surgical margins are sent for pathological examination. This step is vital for determining whether any tumor cells remain at the margins of the excised tissue.
  • Step 5: Resection of Positive Margins If the pathological examination reveals positive margins for tumor invasion, the surgeon performs piecemeal resection of any gross tumor extension until all margins are confirmed to be free of visible and microscopic evidence of tumor.
  • Step 6: Removal of Additional Structures The procedure may also involve the removal of skin, soft tissue, cartilage, and bone as necessary to ensure complete excision of the tumor and affected areas.
  • Step 7: Neck Dissection In conjunction with the radical excision, a radical neck dissection is performed, which includes the dissection and excision of lymph node groups levels I-V, the sternocleidomastoid muscle, the internal jugular vein, and the submandibular gland on the affected side. Additionally, the anterior belly of the digastric muscle, sternohyoid, and sternothyroid muscles may also be removed as part of this comprehensive approach.

3. Post-Procedure

After the completion of the radical excision and neck dissection, post-procedure care is essential for optimal recovery. Patients may require monitoring for complications such as infection, bleeding, or damage to surrounding structures, particularly the facial nerve. Pain management and wound care are critical components of post-operative care. The physician may provide specific instructions regarding activity restrictions and follow-up appointments to assess healing and any further treatment needs. If reconstruction of the external auditory canal is necessary, this may be performed in a separate procedure, and the use of skin grafts may be indicated to restore the integrity of the canal. Regular follow-up visits will be necessary to monitor for any signs of recurrence or complications related to the surgery.

Short Descr EXTENSIVE EAR/NECK SURGERY
Medium Descr RAD EXC XTRNL AUDITORY CANAL LES NCK DSJ
Long Descr Radical excision external auditory canal lesion; with neck dissection
Status Code Active Code
Global Days 090 - Major Surgery
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 2 - Payment restriction for assistants at surgery does not apply to this procedure...
Co-Surgeons (62) 1 - Co-surgeons could be paid, though supporting documentation is required...
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Inpatient Procedures, not paid under OPPS
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P1G - Major procedure - Other
MUE 1
CCS Clinical Classification 26 - Other therapeutic ear procedures
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
58 Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
62 Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate.
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
GC This service has been performed in part by a resident under the direction of a teaching physician
LT Left side (used to identify procedures performed on the left side of the body)
RT Right side (used to identify procedures performed on the right side of the body)
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