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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 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.
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The procedure is indicated for various conditions affecting the tympanic membrane and middle ear structures, including:
The procedure involves several critical steps to ensure effective repair and reconstruction:
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) |
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| 2009-01-01 | Changed | Code description changed |
| Pre-1990 | Added | Code added. |
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