Question: Is ossicular chain reconstruction the same as underlay temporal fascia graft (TFG)?
Alabama Subscriber
Answer: No, these are two different procedures that reconstructive ear surgery may involve.
In ossicular chain reconstruction, the surgeon repairs a defect or eroded middle-ear bone using the patient’s ossicles (tiny ear bones). You should not code this reconstruction separately, but with a tympanoplasty-with- mastoidectomy code that includes an ossicular chain reconstruction component.
Tympanoplasty with mastoidectomy with ossicular reconstruction falls under three codes:
• 69642 -- Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with ossicular chain reconstruction: APC 0256
• 69644 -- ... with intact or reconstructed canal wall, with ossicular chain reconstruction: APC 0256
• 69646 -- ... radical or complete, with ossicular chain reconstruction: APC 0256.
The physician may harvest temporalis fascia, a sheet of fibrous tissue that covers the temporal muscle in the jaw, to repair an ear perforation. Because a temporal fascia graft includes tissue only, the corresponding code is 20926 (Tissue grafts, other [e.g., paratenon, fat, dermis]: APC 0135).
Tympanoplasty-with-mastoidectomy codes 69642-69646 include a graft from the same site. If the graft involves a separate site, you may separately report the graft.
Insurers may now subject 20926 to a multiple procedure reduction. CPT 2008 eliminated the code’s modifier 51 (Multiple procedures) exempt status.
