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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 complex as it may involve additional techniques such as canalplasty, atticotomy, and middle ear surgery, along with the repair of the tympanic membrane itself. Tympanoplasties are categorized based on the extent of the repair needed; they can be classified as simple, where only the tympanic membrane is repaired, or more complex, where the ossicular chain, which consists of small bones in the middle ear, also requires reconstruction. The procedure typically involves creating an osseous channel into the temporal bone, referred to as an antrotomy, or into the mastoid bone, known as a mastoidotomy, to facilitate drainage of any accumulated fluid or infection. The surgical approach may be through the ear canal or via a post-auricular incision, depending on the specific case and the surgeon's preference. If the external auditory canal is narrowed due to recurrent infections, a canalplasty is performed to widen it. During the procedure, the surgeon inspects the tympanic membrane and middle ear structures, removes any scar tissue, and may perform an atticotomy to access the tympanic attic. The tympanic membrane is then repaired, which may involve rimming the edges of the perforation to promote healing or using a graft if the hole is larger. In cases where ossicular chain reconstruction is necessary, the surgeon evaluates the ossicles and may reconstruct them using harvested tissue grafts or synthetic prostheses, depending on the specific requirements of the case.
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The tympanoplasty with antrotomy or mastoidotomy procedure is indicated for various conditions affecting the tympanic membrane and middle ear structures. The following are explicitly provided indications for this procedure:
The procedure involves several critical steps to ensure effective repair and reconstruction. The following procedural steps are outlined:
Post-procedure care is essential for optimal recovery and includes monitoring for any signs of infection or complications. Patients are typically advised to keep the ear dry and avoid any activities that may introduce water into the ear canal. Follow-up appointments are necessary to assess the healing of the tympanic membrane and the success of the ossicular chain reconstruction, if performed. Pain management may be provided as needed, and patients should be educated on signs of potential complications, such as increased pain, discharge, or changes in hearing, which should prompt immediate medical attention.
| Short Descr | REBUILD EARDRUM STRUCTURES | Medium Descr | TYMPP ANTRT/MASTOID W/OSSICULAR CHAIN RECNSTJ | Long Descr | Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with 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) | 0 - 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. | 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). | 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). | 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. | 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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