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Official Description

Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, without ossicular chain reconstruction

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

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 operation is indicated for patients suffering from chronic ear infections, cholesteatoma, or other conditions that compromise the integrity of the middle ear and surrounding structures. The procedure may involve additional techniques such as canalplasty, which is the widening of the ear canal, and middle ear surgery to address any abnormalities or damage within the ear. The classification of tympanoplasties is based on the extent of the repair needed; in this case, the procedure is categorized as a radical or complete mastoidectomy, which entails a significant removal of mastoid bone to create a single cavity that encompasses both the mastoid and the ear canal. The surgical approach typically involves an incision behind the ear to access the mastoid bone, allowing for thorough inspection and removal of any infected tissue, debris, and purulent matter. The goal of this procedure is to restore hearing, eliminate infection, and prevent future complications while ensuring the structural integrity of the ear is maintained.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The tympanoplasty with mastoidectomy procedure is indicated for the following conditions:

  • Chronic Ear Infections: Persistent infections that do not respond to medical treatment may necessitate surgical intervention to prevent further complications.
  • Cholesteatoma: The presence of a cholesteatoma, which is an abnormal skin growth in the middle ear, can lead to bone destruction and requires surgical removal.
  • Perforated Tympanic Membrane: A hole or tear in the tympanic membrane that affects hearing and may lead to recurrent infections is an indication for repair.
  • Mastoiditis: Infection of the mastoid bone that can result from untreated ear infections may require a mastoidectomy to remove infected tissue.

2. Procedure

The procedure involves several critical steps to ensure effective treatment of the ear condition:

  • Step 1: Incision and Exposure: An incision is made behind the ear to expose the mastoid bone. This allows the surgeon to access the mastoid air cells and the middle ear structures.
  • Step 2: Inspection and Removal: The mastoid air cells are inspected, and any infected tissue, debris, or purulent matter is removed. This step is crucial for eliminating sources of infection.
  • Step 3: Canalplasty (if necessary): If the external auditory canal is narrowed due to repeated infections, a canalplasty is performed using a drill to increase the diameter of the canal.
  • Step 4: Tympanic Membrane Repair: The tympanic membrane is inspected, and any scar tissue is removed. The edges of the perforation are rimmed to promote healing, and a graft may be placed if the hole is large.
  • Step 5: Graft Placement: A graft, which may consist of skin, fat, tendon, or fascia, is harvested and placed over the tympanic membrane hole. An absorbable sponge may be used to support the graft.
  • Step 6: Packing and Closure: The ear canal is packed with gauze to protect the graft and promote healing. If canalplasty was performed, skin grafts are also placed over the exposed bone in the canal.

3. Post-Procedure

After the tympanoplasty with mastoidectomy, patients are typically monitored for any immediate complications. Post-operative care may include pain management, instructions for keeping the ear dry, and follow-up appointments to assess healing. Patients may experience some swelling and discomfort, which is expected as part of the recovery process. It is essential to follow the surgeon's guidelines regarding activity restrictions and care of the surgical site to ensure optimal healing and prevent infection.

Short Descr REVISE MIDDLE EAR & MASTOID
Medium Descr TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/O OCR
Long Descr Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, 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
LT Left side (used to identify procedures performed on the left 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.
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
RT Right side (used to identify procedures performed on the right side of the body)
SG Ambulatory surgical center (asc) facility service
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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