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Official Description

Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

A tympanoplasty without mastoidectomy is a surgical procedure aimed at repairing the tympanic membrane (eardrum) and possibly addressing issues within the middle ear, without the need for mastoidectomy, which involves the removal of the mastoid bone. This procedure can be performed as an initial surgery or as a revision of a previous tympanoplasty. It may include additional techniques such as canalplasty, which is the widening of the ear canal, and atticotomy, which involves accessing the attic of the middle ear. The primary focus of this procedure is to repair the tympanic membrane without reconstructing the ossicular chain, which consists of the small bones in the middle ear that are crucial for hearing. The surgery can be approached through the ear canal or via a post-auricular incision, depending on the specific circumstances of the patient's condition. If the external auditory canal is narrowed due to recurrent infections, a canalplasty is performed to enhance access. During the procedure, the surgeon inspects the tympanic membrane and middle ear structures, removes any scar tissue, and prepares the site for grafting. The grafting process involves harvesting tissue, which may include skin, fat, tendon, or fascia, to cover the perforation in the tympanic membrane. The procedure is designed to restore the integrity of the eardrum and improve hearing, while also addressing any underlying issues in the middle ear without the complexity of ossicular chain reconstruction.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The tympanoplasty without mastoidectomy is indicated for various conditions affecting the tympanic membrane and middle ear. The following are explicitly provided indications for this procedure:

  • Perforated Tympanic Membrane - A hole or tear in the eardrum that may result from infection, trauma, or chronic ear disease.
  • Chronic Otitis Media - Persistent inflammation or infection of the middle ear that can lead to tympanic membrane damage.
  • Recurrent Ear Infections - Frequent episodes of ear infections that may compromise the integrity of the tympanic membrane.
  • Middle Ear Pathology - Conditions affecting the middle ear structures that necessitate surgical intervention to restore function and hearing.

2. Procedure

The procedure for tympanoplasty without mastoidectomy involves several detailed steps, which are outlined as follows:

  • Step 1: Anesthesia and Preparation - The patient is placed under general anesthesia or local anesthesia with sedation. The surgical site is prepared and draped to maintain a sterile environment.
  • Step 2: Accessing the Tympanic Membrane - The surgeon may choose to access the tympanic membrane through the ear canal or via a post-auricular incision, depending on the specific case and the condition of the ear.
  • Step 3: Canalplasty (if necessary) - If the external auditory canal is stenosed due to repeated infections, a canalplasty is performed. This involves using a drill to remove bone and increase the diameter of the canal, allowing better access to the tympanic membrane.
  • Step 4: Inspection and Preparation of the Tympanic Membrane - The tympanic membrane is inspected for any damage. Scar tissue in the middle ear is removed, and the edges of the perforation are prepared by rimming until bleeding occurs, which promotes healing.
  • Step 5: Atticotomy (if indicated) - If necessary, an atticotomy is performed by removing the scutum or drilling the posterosuperior bony ear canal to access the attic of the middle ear.
  • Step 6: Graft Harvesting and Preparation - A small amount of tissue, such as skin, fat, tendon, or fascia, is harvested from another site on the body. This graft is prepared for placement over the perforation in the tympanic membrane.
  • Step 7: Graft Placement - The graft is placed over the hole in the tympanic membrane. If a canalplasty was performed, skin grafts are also placed over the exposed bone in the external auditory canal.
  • Step 8: Support and Packing - An absorbable sponge material may be placed in the middle ear behind the graft to support it. An absorbable sponge is also placed in the ear canal over the tympanic membrane graft to hold it in place. Finally, the ear is packed with gauze to protect the surgical site.

3. Post-Procedure

After the tympanoplasty without mastoidectomy, the patient is monitored in a recovery area until the effects of anesthesia wear off. Post-operative care includes instructions for keeping the ear dry and avoiding activities that may increase pressure in the ear, such as heavy lifting or straining. Follow-up appointments are scheduled to assess the healing of the tympanic membrane and the success of the graft. Patients may experience some discomfort, which can be managed with prescribed pain medications. It is important to monitor for any signs of infection or complications during the recovery period.

Short Descr REPAIR EARDRUM STRUCTURES
Medium Descr TYMPANOPLASTY W/O MASTOIDECT W/O OSSICLE RECNSTJ
Long Descr Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction
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) 1 - Statutory payment restriction for assistants at surgery applies 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
ASC Payment Indicator Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P5E - Ambulatory procedures - other
MUE 1
CCS Clinical Classification 22 - Tympanoplasty
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)
GC This service has been performed in part by a resident under the direction of a teaching physician
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).
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.
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
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.
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79 Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
CR Catastrophe/disaster related
GW Service not related to the hospice patient's terminal condition
SG Ambulatory surgical center (asc) facility service
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
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