Coding Ahead
CasePilot
Medical Coding Assistant
Case2Code
Search and Code Lookup Tool
CareerCenter
Medical Coding Job Board
Log in Register free account

Need help choosing the right code?

Ask CasePilot about procedures, modifiers, bundling, and coding guidance.

Try CasePilot

Official Description

Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis [PORP], total ossicular replacement prosthesis [TORP])

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

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 performed solely to repair the tympanic membrane or may also involve the reconstruction of the ossicular chain, which consists of small bones in the middle ear that are crucial for hearing. The procedure includes creating an osseous channel into the temporal bone (antrotomy) or the mastoid bone (mastoidotomy) to facilitate drainage, which is essential in cases of chronic ear infections or other middle ear pathologies. The surgical approach can be 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 widen it. The surgeon inspects the tympanic membrane and middle ear structures, removing any scar tissue that may impede function. The tympanic attic may be accessed through an atticotomy, which involves removing a thin bony plate or drilling into the ear canal. The tympanic membrane is then repaired, which may involve techniques such as rimming the edges of the perforation or using grafts to cover larger defects. The use of synthetic prostheses, such as partial or total ossicular replacement prostheses, is integral to this procedure when reconstruction of the ossicular chain is necessary, ensuring improved hearing outcomes for the patient.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The procedure is indicated for various conditions affecting the tympanic membrane and middle ear structures, including:

  • Chronic Otitis Media: Persistent inflammation or infection of the middle ear that may lead to tympanic membrane perforation.
  • Tympanic Membrane Perforation: A hole or tear in the eardrum that can result from infection, trauma, or other medical conditions.
  • Ossicular Chain Dysfunction: Malfunction or damage to the ossicles, which may require reconstruction to restore hearing.
  • Cholesteatoma: An abnormal skin growth in the middle ear that can erode bone and disrupt normal ear function.
  • Middle Ear Tumors: Presence of benign or malignant growths that necessitate surgical intervention.

2. Procedure

The procedure involves several critical steps to ensure effective repair and reconstruction:

  • Step 1: Anesthesia Administration The patient is placed under general anesthesia to ensure comfort and immobility during the procedure.
  • Step 2: Surgical Access The surgeon may access the middle ear through the ear canal or a post-auricular incision, depending on the specific case and the extent of the required intervention.
  • Step 3: Canalplasty (if indicated) If the external auditory canal is stenosed, a canalplasty is performed to widen the canal. This involves using a drill to remove bone and increase the canal's diameter.
  • Step 4: Inspection and Preparation The tympanic membrane and middle ear structures are inspected. Any scar tissue present in the middle ear is removed to facilitate healing and restore function.
  • Step 5: Atticotomy (if indicated) The tympanic attic may be accessed through an atticotomy, which involves removing the scutum or drilling into the posterosuperior bony ear canal to allow for better access to the middle ear.
  • Step 6: Drilling for Drainage An osseous channel is drilled into the antrum or mastoid cavity to facilitate drainage, which is crucial for preventing future infections.
  • Step 7: Tympanic Membrane Repair The tympanic membrane is repaired by rimming the edges of the perforation until bleeding occurs, which promotes healing. For larger holes, a graft may be necessary.
  • Step 8: Graft Harvesting and Placement A small amount of skin, fat, tendon, or fascia is harvested to prepare a graft. An absorbable sponge may be placed in the middle ear to support the graft, which is then positioned over the perforation.
  • Step 9: Ossicular Chain Reconstruction If ossicular chain reconstruction is required, the surgeon inspects the ossicles and reconstructs them using a synthetic prosthesis, such as a partial or total ossicular replacement prosthesis (PORP or TORP).
  • Step 10: Final Packing The ear canal is packed with gauze, and an absorbable sponge is placed over the tympanic membrane graft to hold it in place during the healing process.

3. Post-Procedure

Post-procedure care involves monitoring the patient for any signs of complications, such as infection or excessive bleeding. Patients are typically advised to keep the ear dry and may be prescribed antibiotics to prevent infection. Follow-up appointments are essential to assess the healing of the tympanic membrane and the success of the ossicular chain reconstruction. Patients may experience some discomfort or hearing changes during the recovery period, which should gradually improve as healing progresses. It is important for patients to adhere to the post-operative instructions provided by their healthcare provider to ensure optimal recovery and outcomes.

Short Descr REBUILD EARDRUM STRUCTURES
Medium Descr TMPP ANTRT/MASTOIDOTOMY PROSTHESIS TORP
Long Descr Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis [PORP], total ossicular replacement prosthesis [TORP])
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.
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.
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)
Date
Action
Notes
2009-01-01 Changed Code description changed
Pre-1990 Added Code added.
Code
Description
Code
Description
Code
Description
Code
Description
CasePilot

Get instant expert-level medical coding assistance.

Ask about:
CPT Codes Guidelines Modifiers Crosswalks NCCI Edits Compliance Medicare Coverage
Example: "What is CPT code 99213?" or "Guidelines for E/M services"