Otolaryngology Coding Alert

Question: An otolaryngologist enters the middle ear through a canal skin flap, removes disease and uses "PORP" for lateral chain reconstruction. He does not use a graft for the tympanic membrane. Should I still code a tympanoplasty?

Florida Subscriber

Answer: Yes, although the operation required no tympanic membrane repair, you can still code a tympanoplasty. The abbreviation "PORP" stands for "partial ossicular replacement prosthesis insertion" and refers to using a prosthesis to repair a portion of the patient's ossicles (middle ear bones). Code a tympanoplasty with ossicle repair requiring prosthesis insertion with 69633 (Tympanoplasty without mastoidectomy [including canalplasty, atticotomy and/or middle ear surgery], initial or revision; with ossicular chain reconstruction and synthetic prosthesis (e.g., partial ossicular replacement prosthesis [PORP], total ossicular replacement prosthesis [TORP]).

If the surgeon had been able to repair the ossicles without inserting a prosthesis, you would instead report 69632 (Tympanoplasty without mastoidectomy [including canalplasty, atticotomy and/or middle ear surgery], initial or revision; with ossicular chain reconstruction (e.g., postfenestration). For a tympanoplasty without ossicular reconstruction, use 69631 (Tympanoplasty without mastoidectomy [including canalplasty, atticotomy and/or middle ear surgery], initial or revision; without ossicular chain reconstruction).

-- Answers to You Be the Coder and Reader Questions provided/reviewed by Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J.