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A tympanoplasty with mastoidectomy is a surgical procedure that combines the repair of the tympanic membrane (eardrum) with the removal of infected or diseased mastoid bone. This specific procedure, identified by CPT® Code 69643, is performed when the wall of the ear canal is either intact or has been reconstructed. The surgery may involve several components, including canalplasty, which is the widening of the ear canal, middle ear surgery, and the repair of the tympanic membrane itself. 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 the small bones in the middle ear. In this case, the procedure is conducted without any reconstruction of the ossicular chain. During the surgery, an incision is typically made behind the ear to access the mastoid bone, allowing the surgeon to inspect the mastoid air cells and determine the necessary extent of the procedure. The mastoid air cells are carefully removed along with any infected tissue, debris, or purulent matter. If the external auditory canal's posterior and superior walls are removed to facilitate access to the mastoid and attic of the middle ear, these walls are reconstructed afterward. A drain may be placed behind the ear to assist with fluid management post-surgery. If the external auditory canal is narrowed due to recurrent infections, a canalplasty is performed to enlarge the canal. The tympanic membrane is then inspected, and any scar tissue in the middle ear is excised. The repair of the tympanic membrane involves techniques such as rimming the edges of the hole to promote healing or using a graft if the hole is larger. The grafting material, which may include skin, fat, tendon, or fascia, is prepared and placed over the tympanic membrane defect, with absorbable materials used to support the graft. This comprehensive approach aims to restore hearing and prevent further infections while ensuring the structural integrity of the ear.
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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 performing this procedure:
The procedure for tympanoplasty with mastoidectomy involves several critical steps to ensure effective treatment of the ear conditions. The following outlines the procedural steps:
After the tympanoplasty with mastoidectomy, patients can expect a recovery period that may involve specific post-operative care. It is essential to monitor for any signs of infection or complications. Patients are typically advised to keep the ear dry and avoid getting water in the ear canal during the healing process. Follow-up appointments are necessary to assess the healing of the tympanic membrane and the overall success of the procedure. Pain management may be provided as needed, and patients should be informed about potential changes in hearing as they recover. The use of absorbable packing materials means that patients may not require additional procedures for removal, but they should be aware of the importance of adhering to post-operative instructions to ensure optimal recovery.
| Short Descr | REVISE MIDDLE EAR & MASTOID | Medium Descr | TMPP MASTOIDECT NTC/RCNSTED WALL W/O OCR | Long Descr | Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed wall, 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 |
| RT | Right side (used to identify procedures performed on the right side of the body) | 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). | 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.) | CR | Catastrophe/disaster related | 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) | SG | Ambulatory surgical center (asc) facility service | X3 | Episodic/broad services: for reporting services by clinicians who have broad responsibility for the comprehensive needs of the patient that is limited to a defined period and circumstance such as a hospitalization; reporting clinician service examples include but are not limited to the hospitalist's services rendered providing comprehensive and general care to a patient while admitted to the hospital | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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