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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 operation is particularly significant in cases where chronic ear infections have led to complications affecting both the middle ear and the mastoid process, which is the bony structure located behind the ear. 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. Tympanoplasties are categorized based on the extent of the repair needed; they can be classified as simple, where only the tympanic membrane is repaired, or more complex, where the ossicular chain—comprising the malleus, incus, and stapes—also requires reconstruction. In the case of CPT® Code 69646, a radical or complete mastoidectomy is performed using a wall down technique, which entails the removal of bone from the back of the ear canal to create a single cavity that encompasses both the mastoid and the ear canal. During the procedure, an incision is typically made behind the ear to expose the mastoid bone. The surgeon inspects the mastoid air cells and determines the extent of the disease, removing any infected tissue, debris, and purulent matter. The procedure may also involve the removal of the posterior and superior walls of the external auditory canal to facilitate access to the mastoid and attic of the middle ear. If a radical mastoidectomy is necessary, structures within the epitympanum, including parts of the ossicular chain, may be excised to allow for proper drainage and healing. The tympanic membrane is then repaired, which may involve rimming the edges of the perforation to promote healing or using a graft if the hole is larger. The use of absorbable materials to support the graft and packing the ear with gauze are common practices to ensure stability during the healing process. Overall, this procedure aims to restore hearing, eliminate infection, and prevent future complications associated with chronic ear disease.
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The tympanoplasty with mastoidectomy procedure is indicated for patients experiencing chronic ear infections, cholesteatoma, or other conditions that compromise the integrity of the tympanic membrane and the surrounding structures. The following specific indications may warrant this surgical intervention:
The procedure for tympanoplasty with mastoidectomy involves several critical steps to ensure effective treatment of the ear condition. The following outlines the procedural steps:
After the tympanoplasty with mastoidectomy, patients are typically monitored in a recovery area until the effects of anesthesia wear off. Post-operative care includes managing pain with prescribed medications and keeping the surgical site clean and dry. Patients may be advised to avoid getting water in the ear and to refrain from blowing their nose to prevent pressure changes that could affect healing. Follow-up appointments are essential to assess the healing process and to remove any packing or sutures as necessary. The expected recovery time can vary, but patients should be informed about potential signs of complications, such as increased pain, fever, or drainage from the ear, which should prompt immediate medical attention.
| Short Descr | REVISE MIDDLE EAR & MASTOID | Medium Descr | TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/OCR | Long Descr | Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, 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) | 0 - 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. | 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. | 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) | SG | Ambulatory surgical center (asc) facility service |
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