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Otolaryngology Coding Alert

You Be the Coder:

Determine if You Need More Than 69641

Published on Tue Jun 17, 2014

Question: I have a question regarding harvesting of graft(s) during tympanomastoidectomy. The otolaryngologist states he harvested a large temporalis graft as well as a tragal cartilage graft during the procedure. He placed the tragal cartilage graft lateral to the chordatympani on the surface of the malleus. The temporalis fascia graft was placed in an underlay fashion underneath the tympanomeatal flap. I know the graft is included if it’s obtained from the same site. Would both of these grafts be included in the procedure code 69641?

Connecticut Subscriber

Answer: For a same-side tympanoplasty with mastoidectomy, choose the appropriate code from 69641-69646, such as 69641 (Tympanoplasty with mastoidectomy [including canalplasty, middle ear surgery, tympanic membrane repair]; without ossicular chain reconstruction). Include the graft incision in the tympanoplasty with mastoidectomy. 
 
Here’s why: Tympanic repair by definition involves some form of graft. Therefore, grafts performed in conjunction with a myringoplasty or tympanoplasty usually are not separately payable. Some otolaryngologists believe that if a tympanoplasty is performed through the ear canal and that a second incision must be made to harvest the cartilage for the graft, the graft is payable separately. However, that is not the case, unless the graft occurs on the other side from the tympanoplasty with mastoidectomy. 
 
Harvesting the graft is by convention included in myringoplasty, which CPT® code defines in 69620 as surgery confined to drumhead and donor area. This means the donor-area incision is included in the procedure, and the same logic applies to grafts performed during tympanoplasties.
 
Exceptions: If the otolaryngologist performs a tympanoplasty with mastoidectomy on one side and, because of prior surgery, has to go to the opposite side to obtain a cartilage graft, you should consider the graft separate. Documentation must show the prior surgery and lack of cartilage. In these cases, report 21235 (Graft; ear cartilage, autogenous, to nose or ear [includes obtaining graft]).

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