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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 procedure is performed when there is a need to address issues within the middle ear and mastoid area, particularly when the canal wall is either intact or has been reconstructed. The tympanoplasty aspect focuses on repairing the tympanic membrane, which may involve the reconstruction of the ossicular chain, the series of small bones in the middle ear that are crucial for hearing. The procedure may also include canalplasty, which is the widening of the external auditory canal, especially in cases where the canal has become narrowed due to repeated infections. 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 extent of the disease. The procedure involves the removal of any infected tissue, debris, and purulent matter from the mastoid air cells. If necessary, the walls of the external auditory canal may be reconstructed after the mastoidectomy. The tympanic membrane is then repaired, which may involve techniques such as rimming the edges of the perforation or using a graft to cover larger holes. The overall goal of this procedure is to restore hearing and prevent future infections by addressing both the tympanic membrane and the underlying structures of the ear.
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The tympanoplasty with mastoidectomy procedure is indicated for various conditions affecting the middle ear and mastoid area. These include:
The tympanoplasty with mastoidectomy procedure involves several detailed steps to ensure effective treatment of the ear conditions. The following procedural steps are typically performed:
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. Patients may experience some discomfort, which can be managed with prescribed pain medications. Follow-up appointments are essential to assess the healing of the tympanic membrane and the success of the ossicular chain reconstruction, if performed. The expected recovery time can vary, but patients are generally advised to avoid strenuous activities and heavy lifting for a specified period to ensure proper healing.
| Short Descr | REVISE MIDDLE EAR & MASTOID | Medium Descr | TMPP MASTOIDECT NTC/RCNSTED CANAL WALL OCR | Long Descr | Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed canal wall, 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 |
| 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. | 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. | 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.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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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