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A tympanoplasty with antrotomy or mastoidotomy is a surgical procedure aimed at repairing the tympanic membrane (eardrum) and addressing issues within the middle ear. This procedure is particularly relevant for patients experiencing chronic ear infections, perforated eardrums, or other middle ear pathologies. The term 'tympanoplasty' refers specifically to the reconstruction of the tympanic membrane, while 'antrotomy' and 'mastoidotomy' involve creating an opening in the mastoid bone or the antrum, which is a cavity within the temporal bone, to facilitate drainage and access to the middle ear structures. The procedure may also include additional interventions such as canalplasty, which enlarges the ear canal, and atticotomy, which involves accessing the attic of the middle ear. Importantly, CPT® Code 69635 specifies that this procedure is performed without ossicular chain reconstruction, meaning that the small bones of the middle ear (ossicles) are not being repaired or replaced during this surgery. The approach can be through the ear canal or via a post-auricular incision, depending on the specific clinical scenario. The overall goal of this procedure is to restore hearing and prevent further complications by addressing the underlying anatomical issues within the ear.
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The tympanoplasty with antrotomy or mastoidotomy procedure is indicated for various conditions affecting the middle ear and tympanic membrane. These include:
The procedure for tympanoplasty with antrotomy or mastoidotomy involves several detailed steps to ensure effective repair and restoration of ear function. Each step is critical to the overall success of the surgery.
After the tympanoplasty with antrotomy or mastoidotomy, patients are typically monitored for a short period in a recovery area. Post-operative care includes instructions on keeping the ear dry and avoiding activities that may increase pressure in the ear, such as heavy lifting or straining. Pain management may be provided as needed, and follow-up appointments are scheduled to assess healing and the success of the procedure. Patients may experience some temporary hearing loss as swelling subsides, but hearing is expected to improve as the tympanic membrane heals. It is essential to follow the surgeon's post-operative care instructions to ensure optimal recovery and prevent complications.
| Short Descr | REPAIR EARDRUM STRUCTURES | Medium Descr | TYMPP ANTRT/MASTOID W/O OSSICULAR CHAIN RECNSTJ | Long Descr | Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); 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 |
| 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). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) 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). | 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.) | 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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