# Tympanoplasty & Encephalocele removal w closure



## dyoungberg (Dec 12, 2012)

I need some coding guidance please.  In an ASC setting doctor performed the following procedure:

_PROCEDURE: RIGHT EXPLORATION OF MASTOID WITH TYMPANOPLASTY AND REMOVAL OF ENCEPHALOCELE WITH CLOSURE OF DEFECT WITH CADAVERIC CARTILAGE 

COMPLICATIONS:  NONE

OPERATIVE FINDINGS: The mastoid cavity was lined with healthy mucosa. There was a large bulging area almost completely filling the mastoid cavity from the posterior side. On elevation of the mastoid lining it became apparent that this bulging was a large necrotic encephalocele. This was found to have a defect involving almost the complete tegmen. The TM was intact. The TM was adherent to the ossicular chain in several areas with dense fibrous tissue, as well as the promontory. There was no evidence of middle ear infection. 

PROCEDURE:  Under general anesthesia, the patient was prepped and draped in a sterile manner in order to give good exposure to the right ear. The area was infiltrated with about 10 cc Lidocaine 1% with epinephrine 1:100,000. A postauricular incision was reopened with the cutting Bovie and the mastoid lining dissected out of the mastoid cavity and separated from the underlying encephalocele which was obviously nonviable. The TM attached to the mastoid lining was elevated and the adhesions in the middle ear lysed with a sickle knife and Bellucci scissors. The necrotic encephalocele was suctioned out with the #5 and #3 suctions and the stump reduced into the cerebral cavity. Two large pieces of cadaveric fresh frozen cartilage was cut to size and placed into the defect side-by-side with lips overhanging into the cranial cavity. These secured the cranial contents well. The mastoid lining was then replaced and the mastoid bowl and external canal packed fairly tightly with Gelfoam moistened with Ocuflox. The postauricular incision was closed with 3-0 Vicryl in the fascial and subcutaneous planes. The skin was closed with Steri-strips and a bulky mastoid dressing placed. The patient was awakened and returned to the recovery room in good condition. There were no complications. _

I chose 62120 & 69631 as my codes, however 62120 is not a covered procedure in an ASC setting.  What coding should I be using for this procedure?

Thanks a bunch in advance!

Debbie


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## dawnygirl (Dec 12, 2012)

The codes you chose, 62120 and 69631 would be correct, however you are also correct the ASC will not be reimbursed for 62120. I do believe the physician will be reimbursed, but not the ASC, as it is a procedure that should be done in the hospital due to risk. Alert your providers that this procedure, as well as skull base surgeries should be scheduled at the hospital. 
Dawn M, CPC, CENTC


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