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A stapedectomy or stapedotomy is a surgical procedure aimed at treating conductive hearing loss caused by the fixation of the stapes bone, often due to a condition known as otosclerosis. In a healthy ear, the stapes bone vibrates freely, allowing sound to be transmitted effectively into the inner ear. However, when abnormal bone growth occurs around the stapes, it can become fixed, leading to impaired sound transmission and subsequent hearing loss. The procedure involves making an incision in the posterior wall of the ear canal to create a tympanomeatal flap, which is then elevated to expose the ossicles of the middle ear for inspection. Depending on the severity and location of the otosclerosis, the surgeon may perform a stapedectomy, which involves the excision of part or all of the stapes, or a stapedotomy, where the stapes is drilled to create an opening. In cases where the stapes is removed, a synthetic prosthesis is typically inserted to restore ossicular continuity. This procedure may also involve additional techniques, such as a footplate drillout, where a small hole is created in the footplate of the stapes to facilitate the placement of a prosthetic rod, ensuring that sound vibrations are effectively transmitted to the inner ear. The surgical site is then closed by replacing the tympanomeatal flap and suturing the incision, allowing for recovery and restoration of hearing function.
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The stapedectomy or stapedotomy procedure is indicated for patients experiencing conductive hearing loss due to the fixation of the stapes bone, primarily resulting from otosclerosis. This condition leads to abnormal bone growth around the stapes, preventing it from vibrating freely and transmitting sound effectively to the inner ear. The procedure is performed to restore hearing by re-establishing ossicular continuity, which may involve the excision of the stapes or drilling into it.
The stapedectomy or stapedotomy procedure involves several critical steps to ensure successful restoration of hearing. Initially, the surgeon makes an incision in the posterior ear canal wall to create a tympanomeatal flap. This flap is carefully elevated to expose the ossicles of the middle ear, allowing for thorough inspection. Depending on the extent of the otosclerosis, the surgeon will then proceed with either a stapedectomy or a stapedotomy. In a stapedectomy, part or all of the stapes is excised to eliminate the fixation. Alternatively, in a stapedotomy, the stapes is drilled to create an opening while leaving the footplate intact. If the stapes is removed, a synthetic prosthesis is inserted to replace it and restore the continuity of the ossicular chain. In some cases, a footplate drillout may be performed, where the upper portion of the stapes is removed, and a small hole is created in the fixed footplate using a laser or drill. A prosthetic rod is then placed over the incus and into this hole, ensuring that sound vibrations can be transmitted effectively to the inner ear. After confirming the proper movement of the prosthesis, any surgically created defects in the oval window are repaired, which may involve the use of a mesodermal graft or placement of gelfilm or gelfoam. Finally, the tympanomeatal flap is replaced, and the meatal incision is closed with sutures to complete the procedure.
After the stapedectomy or stapedotomy procedure, patients are typically monitored for any immediate complications. Post-operative care may include pain management and instructions for activity restrictions to promote healing. Patients are advised to avoid getting water in the ear and to refrain from blowing their nose forcefully, as these actions can affect the surgical site. Follow-up appointments are essential to assess the success of the procedure and monitor hearing restoration. The expected recovery time may vary, but many patients experience improvements in hearing within a few weeks following the surgery. Any additional considerations, such as the need for hearing aids or further interventions, will be discussed during follow-up visits.
| Short Descr | REVISE MIDDLE EAR BONE | Medium Descr | STAPEDECTOMY/STAPEDOTOMY | Long Descr | Stapedectomy or stapedotomy with reestablishment of ossicular continuity, with or without use of foreign material; | 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 | 26 - Other therapeutic ear procedures |
| 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). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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. | 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) | 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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| 2010-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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