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The procedure described by CPT® Code 69670, known as mastoid obliteration, is a surgical intervention aimed at reducing the size of the mastoid cavity that results from a prior mastoidectomy. A mastoidectomy is a surgical procedure that involves the removal of infected air cells within the mastoid bone, which is located behind the ear. Following this procedure, a cavity is often left behind, which can lead to complications such as infection or the need for further surgical intervention. Mastoid obliteration addresses these issues by filling the cavity to promote healing and prevent future complications. The surgery is typically performed using a postauricular approach, which involves making an incision behind the ear to access the mastoid cavity. During the procedure, the surgeon may create a local flap or utilize a free flap or graft made from bone, cartilage, and/or fat. A common technique involves the use of autogenous cranial bone, which is bone harvested from the patient's own skull. This bone is processed and combined with an antibiotic solution to create a paste that is then used to fill the mastoid cavity. The goal of this procedure is to induce the formation of new bone, effectively obliterating the cavity and epitympanic spaces, thereby restoring normal anatomy and function. After the graft material is placed, the incision is closed, completing the procedure.
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The procedure of mastoid obliteration (CPT® Code 69670) is indicated for patients who have undergone a mastoidectomy and are experiencing complications or issues related to the residual mastoid cavity. The following conditions may warrant this procedure:
The mastoid obliteration procedure involves several key steps to ensure effective closure of the mastoid cavity. The following outlines the procedural steps:
Following the mastoid obliteration procedure, patients are typically monitored for any immediate complications. Post-operative care may include pain management, instructions for wound care, and follow-up appointments to assess healing. Patients may experience some swelling and discomfort in the area, which is expected and can be managed with prescribed medications. It is important for patients to adhere to any activity restrictions and attend follow-up visits to ensure proper recovery and to monitor for any signs of infection or complications related to the graft. The expected outcome is a reduction in the size of the mastoid cavity, improved ear function, and a lower risk of future infections.
| Short Descr | REMOVE MASTOID AIR CELLS | Medium Descr | MASTOID OBLITERATION SEPARATE PROCEDURE | Long Descr | Mastoid obliteration (separate procedure) | 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) | 2 - Payment restriction for assistants at surgery does not apply 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). | 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.) | 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) | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 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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| Pre-1990 | Added | Code added. |
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