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A tympanoplasty with mastoidectomy is a surgical procedure that involves the repair of the tympanic membrane (eardrum) and the mastoid bone, which is located behind the ear. This procedure is often necessary when there is damage to the tympanic membrane or the surrounding structures due to chronic ear infections, trauma, or other medical conditions. The surgery may include additional procedures such as canalplasty, which is the widening of the ear canal, and middle ear surgery to address any issues within the middle ear. The tympanic membrane repair can vary in complexity, depending on whether only the membrane needs to be fixed or if the ossicular chain, which consists of small bones in the middle ear, also requires reconstruction. During the tympanoplasty with mastoidectomy, an incision is typically made behind the ear to access the mastoid bone. The surgeon inspects the mastoid air cells to assess the extent of any infection or damage. If necessary, a simple mastoidectomy is performed to remove infected tissue and debris. The procedure may also involve the placement of a drain to facilitate healing. If the external auditory canal is narrowed due to repeated infections, a canalplasty is performed to enlarge the canal. The tympanic membrane is carefully inspected, and any scar tissue is removed before the membrane is repaired. Depending on the size and location of any perforations, the repair may involve simply rimming the edges or using a graft. In cases where ossicular chain reconstruction is indicated, the surgeon evaluates the ossicles—specifically the incus, malleus, and stapes—to determine if they need to be reconstructed. Tissue grafts are harvested for this purpose, ensuring that the ossicular chain can function properly to transmit sound. Overall, this procedure aims to restore hearing and prevent further complications associated with ear diseases.
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The tympanoplasty with mastoidectomy procedure is indicated for various conditions affecting the ear, particularly when there is damage or dysfunction of the tympanic membrane and surrounding structures. The following are specific indications for this procedure:
The tympanoplasty with mastoidectomy procedure involves several detailed steps to ensure effective repair and restoration of ear function. 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 during the healing process. Pain management may be provided, and follow-up appointments are essential to assess the healing of the tympanic membrane and the success of the ossicular chain reconstruction, if performed. Patients may also be advised on signs of infection or complications to watch for as they recover. The expected recovery time can vary, but patients are generally encouraged to avoid strenuous activities for a specified period to ensure optimal healing.
| Short Descr | REVISE MIDDLE EAR & MASTOID | Medium Descr | TMPP MASTOIDECTOMY W/OSSICULAR CHAIN RECNSTJ | Long Descr | Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, 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) | 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 |
| 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). | 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. | 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. | 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.) | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 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) | SG | Ambulatory surgical center (asc) facility service |
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