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 decision can understand the service.

Comparison shopping: The closest match for comparison would probably be under skull repair 62140 (Cranioplasty for skull defect; up to 5 cm diameter) with a separate code for cartilage graft, or 62146 (Cranioplasty with autograft [includes obtaining bone grafts]; up to 5 cm diameter). They're not exact, but you'll want to include a comparison code to help the insurer decide the value of the service. Don't wait for her to look it up " she might choose a code valued much lower than the unlisted procedure your physician performed.