Otolaryngology Coding Alert

Question: My physician performed a tympanoplasty with mastoidectomy. During the surgery, he discovered a tegmen tympani cerebrospinal leak. He repaired it by welding it with bipolar cautery and then reinforced it with a layer of cartilage. What is the correct CPT code for that procedure? Virginia Subscriber Answer: CPT doesn't offer a code specific to fixing a hole in the roof of the middle ear, so you should go with the unlisted code (69799, Unlisted procedure middle ear). Correct coding demands that you use a code that most accurately represents the service the physician provides, and not a code that is similar but actually represents a different service. Get ready to write: Reporting an unlisted-procedure code will require a letter of explanation to describe the service. You'll need to include the physician's full documentation of services, but you'll need to explain it in plain English so the person making the [...]