CPT® Code 69605

Official Description

Revision mastoidectomy; with apicectomy

Common Language Description

The procedure described by CPT® Code 69605 is known as a revision mastoidectomy with apicectomy. This surgical intervention is primarily indicated for patients experiencing recurrent infections of the mastoid air cells, particularly when these infections have extended to the petrous apex, which is a part of the temporal bone located at the base of the skull. The procedure begins with an incision made behind the ear, allowing the surgeon to access and expose the mastoid bone. During the operation, the surgeon inspects the remaining mastoid air cells to assess the extent of the infection and determine the necessary revisions. The surgical approach involves the complete removal of the air cell system, along with any purulent matter, debris, and infected tissue that may be present. Additionally, critical structures within the epitympanum, which is the upper portion of the tympanic cavity, are addressed. This includes the removal of the head of the malleus and the body of the incus, which are important components of the middle ear. While the stapes, another ossicle in the ear, may also be removed during this procedure, efforts are made to preserve it whenever possible. The removal of these structures facilitates the exteriorization of the mastoid cavity and the middle ear, which is essential for effective treatment of the infection. To gain access to the petrous apex, the anterior wall of the ear canal is removed, and in some cases, the condyle of the mandible may be excised. The tensor muscle of the tympanic membrane is avulsed, and the tensor semicanal is opened to allow for better visualization and access. The surgical team carefully dissects the area between the carotid artery, the cochlea, and the dura mater of the middle fossa to visualize and remove the petrous apex. After all infected tissue has been thoroughly excised, the incisions are closed, and a drain may be placed to facilitate ongoing drainage, ensuring that any residual fluid can be effectively managed post-operatively.

1. Indications

The revision mastoidectomy with apicectomy, as described by CPT® Code 69605, is indicated for the following conditions:

Recurrent Infections This procedure is performed for patients suffering from recurrent infections of the mastoid air cells.
Spread of Infection It is specifically indicated when these infections have spread to the petrous apex, necessitating surgical intervention to remove infected tissue.

2. Procedure

The procedure involves several critical steps to ensure effective treatment of the infection and restoration of ear function:

Incision and Exposure The surgeon begins by making an incision behind the ear to expose the mastoid bone. This access is crucial for the subsequent steps of the procedure.
Inspection of Mastoid Air Cells Once the mastoid bone is exposed, the remaining mastoid air cells are inspected to determine the extent of the infection and the necessary revisions to be performed.
Removal of Infected Tissue The air cell system is completely removed, along with any purulent matter, debris, and infected tissue that may be present, ensuring that all sources of infection are addressed.
Addressing Epitympanum Structures The procedure includes the removal of critical structures within the epitympanum, such as the head of the malleus and the body of the incus, which are essential for hearing.
Preservation of Stapes The stapes may also be removed during the procedure; however, the surgeon will attempt to preserve it whenever possible to maintain hearing function.
Exteriorization of Mastoid Cavity The removal of these structures allows for the exteriorization of the mastoid cavity and the middle ear, facilitating better drainage and healing.
Accessing the Petrous Apex To expose the petrous apex, the anterior wall of the ear canal is removed, which is a critical step in addressing the infection.
Excising Mandibular Condyle In some cases, the condyle of the mandible may be excised to provide better access to the affected area.
Avulsing Tensor Muscle The tensor muscle of the tympanic membrane is avulsed, and the tensor semicanal is opened to enhance visibility and access during the procedure.
Dissection for Visualization The surgeon carefully dissects the triangle between the carotid artery, the cochlea, and the middle fossa dura to visualize and remove the petrous apex.
Closure of Incisions After all infected tissue has been removed, the incisions are closed, and a drain may be placed to allow for continued drainage, ensuring proper post-operative care.

3. Post-Procedure

Post-procedure care for patients undergoing a revision mastoidectomy with apicectomy includes monitoring for any signs of infection, managing pain, and ensuring that the drain, if placed, is functioning properly to allow for continued drainage. Patients may require follow-up visits to assess healing and to ensure that there are no complications arising from the surgery. Recovery time may vary based on the extent of the procedure and the individual patient's health status.

Short Descr	MASTOID SURGERY REVISION
Medium Descr	REVJ MASTOIDECTOMY W/APICECTOMY
Long Descr	Revision mastoidectomy; with apicectomy
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)	1 - 150% payment adjustment for bilateral procedures applies.
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)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Hospital Part B services paid through a comprehensive APC
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	P1G - Major procedure - Other
MUE	Not applicable/unspecified.
CCS Clinical Classification	24 - Mastoidectomy