Coding Tympanoplasty Reconstruction


Vol. 19 • Issue 2 • Page 8
Coding Corner

Pre- and Postoperative Diagnosis: Left ossicular discontinuity

Procedure: Left tympanoplasty with ossicular reconstruction with a Goldenberg partial ossicular reconstruction prosthesis measuring 4.0 mm

Anesthesia: Local with monitored anesthesia care

Procedure Description: The patient was brought to the operating room and placed supine on the table and given some auxilytic medications. The patient’s left external meatus was injected with 1% lidocaine with 1:100,000 epinephrine. The patient was prepped and draped in a sterile fashion. The microscope was brought in. A four-quadrant canal injection was performed with 1% lidocaine with 1:50,000 epinephrine. A tympanomeatal flap was incised in the posterior canal wall using a Beevor blade. The tympanomeatal flap was elevated into the middle ear space. The tympanic membrane was placed anteriorly. Stapes curette was used to remove the posterior superior quadrant of the external auditory canal widely exposing the stapes. The sinus tympany and facial recess were probed, and no cholesteatoma was identified. The stapes was examined. There was no evidence of cholesteatoma persistent on the stapes. The middle ear mucosa appeared healthy, and there was no fusion. The distance between the capitulum of the stapes and the tympanic membrane was measured and found to accommodate an approximately 4 mm prosthesis. A Goldenberg partial ossicular reconstruction prosthesis was chosen and trimmed to 4 mm with a notch provided for the stapedial tendon. The middle ear space was then packed with Gelfoam securely around the prosthesis. The tympanomeatal flap was returned to its normal position and Gelfoam was placed on the back flap. The remainder of the ear canal was packed with Bacitracin ointment. This completed the procedure.

The patient tolerated the procedure well and was sent to the recovery room in stable condition.

ICD-9-CM DIAGNOSIS CODE

385.23 Discontinuity/dislocation of ear ossicles

ICD-9-CM PROCEDURE CODE

19.53 Type III tympanoplasty

CPT PROCEDURE CODES

69633-LT Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction and synthetic prosthesis

Rationale: In the operative report the physician states that a Goldenberg partial ossicular reconstruction prosthesis (PORP) was utilized in the tympanoplasty procedure. The PORP is a synthetic prosthesis used to reconstruct the ossicular chain of the ear.

Your first step in the index is to look under the term Tympanoplasty, then the following:

without Mastoidectomy

with Ossicular Chain Reconstruction

and Synthetic Prosthesis . . . . . . . 69633

You will assign modifier LT to this code to show that the procedure was performed on the left ear.

Peggy Hapner is manager of the HIM consulting division at Medical Learning Inc. (MedLearn), St. Paul, MN.

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