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.