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A tympanoplasty with mastoidectomy is a surgical procedure that involves the repair of the tympanic membrane (eardrum) and the removal of infected or diseased tissue from the mastoid bone, which is located behind the ear. This procedure may also include canalplasty, which is the widening of the ear canal, and middle ear surgery to address various conditions affecting the ear. Tympanoplasties are categorized based on the extent of the repair needed; they can involve only the tympanic membrane or may also require the repair of the ossicular chain, which consists of small bones in the middle ear. In the case of CPT® Code 69641, the procedure is performed without any reconstruction of the ossicular chain. The surgical approach typically begins with an incision made behind the ear to expose the mastoid bone, allowing the surgeon to inspect the mastoid air cells and determine the necessary extent of the procedure. A simple mastoidectomy is performed, which involves the removal of purulent matter, debris, and infected tissue from the mastoid area. The tympanic membrane is then repaired, which may involve techniques such as rimming the edges of a perforation to promote healing or using a graft for larger holes. The procedure may also include the placement of absorbable materials to support the graft and ensure proper healing. Overall, this surgical intervention aims to restore hearing and prevent further complications related to ear infections and structural damage.
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The tympanoplasty with mastoidectomy procedure is indicated for various conditions affecting the ear, particularly when there is a need to repair the tympanic membrane and address issues within the mastoid bone. The following are specific indications for this procedure:
The procedure for tympanoplasty with mastoidectomy involves several detailed steps to ensure effective repair and management of the ear structures. The following outlines the procedural steps:
After the tympanoplasty with mastoidectomy, patients are typically monitored for any immediate complications. Post-procedure care may include instructions for keeping the ear dry and avoiding water exposure to prevent infection. Patients may experience some discomfort, which can be managed with prescribed pain relief. Follow-up appointments are essential to assess the healing of the tympanic membrane and the overall success of the procedure. The expected recovery time can vary, but patients are generally advised to avoid strenuous activities and heavy lifting during the initial healing phase. Additionally, any signs of infection or unusual symptoms should be reported to the healthcare provider promptly for further evaluation.
| Short Descr | REVISE MIDDLE EAR & MASTOID | Medium Descr | TMPP MASTOIDECTOMY W/O OSSICULAR CHAIN RECNSTJ | Long Descr | Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, 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 | 24 - Mastoidectomy |
| 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). | 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. | 73 | Discontinued out-patient hospital/ambulatory surgery center (asc) procedure prior to the administration of anesthesia: due to extenuating circumstances or those that threaten the well being of the patient, the physician may cancel a surgical or diagnostic procedure subsequent to the patient's surgical preparation (including sedation when provided, and being taken to the room where the procedure is to be performed), but prior to the administration of anesthesia (local, regional block(s) or general). under these circumstances, the intended service that is prepared for but cancelled can be reported by its usual procedure number and the addition of modifier 73. note: the elective cancellation of a service prior to the administration of anesthesia and/or surgical preparation of the patient should not be reported. for physician reporting of a discontinued procedure, see modifier 53. | 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.) | 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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