Myringoplasty with excision of cholesteatoma

[AN2114]

There are no ncci edits for cpt codes 69145 excision of cholesteatoma and 69610 myringoplasty. Does anyone know if they can be coded together? Since it is in the same ear I'm thinking they can't be coded together, but I also don't want to just bill out for one procedure thinking I can only do one and we could get paid for both. Any thoughts?

 

[jackjones62]

It depends on your operative note, need more info as there are many ear procedures, can you provide your surgeon's op note?

 

[AN2114]

It depends on your operative note, need more info as there are many ear procedures, can you provide your surgeon's op note?

Here is the op note:

Post operative diagnosis: Left auditory canal and tympanic membrane cholesteatoma and tympanic membrane perforation

Procedure: Excision of left tympanic membrane external auditory canal cholesteatoma and gelfoam myringoplasty


Procedure Details: The patient was seen in preop. The patient was brought back to the OR suite. The patient underwent mask sedation. Once sedated, we did examine the left ear with the microscope. Upon doing so, we did notice the canal cholesteatoma was moving more medial than laterally and was tracking into the middle ear and through the tympanic membrane. It did look like the canal cholesteatoma had obliterated a decent portion of the tympanic membrane. We did fully excise the canal cholesteatoma and were able to remove it in its entirety. It did invade into the middle ear space into the mesotympanum as well. We did remove that. Upon doing so, we did notice the tympanic membrane perforation. We did rough the edges and rim the perforation as well as perform a Gelfoam myringoplasty packing the middle ear and the area around the tympanic membrane perforation with hope that we can stimulator tympanic membrane growth in this area. We did then have a long discussion with the mother about the possible need for a cartilage graft in the future pending on the child hearing. The child hearing was good and was adequate at our last evaluation

 

[jackjones62]

Consider CPT 69631

Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction

Additional/Related Information
The provider reconstructs the tympanic membrane, or eardrum, to repair a perforation. This might involve reconstruction of the ear canal, an incision into the tympanic attic and or other surgeries on the middle ear. The procedure does not include removal of the mastoid and reconstruction of the ossicular chain.

Clinical Responsibility
When the patient is appropriately prepped and anesthetized, the provider incises the ear canal through a postauricular or transcanal approach and roughens the edges of the tympanic membrane, also called rimming the perforation. He reflects the eardrum forward and removes any adhesions, skin debris and or cholesteatoma in the middle ear. He inspects and touches the ossicles but does not perform any reconstruction of the ossicular chain. If needed, the provider reconstructs the ear canal. He harvests a fascial graft or other tissue to repair the tear in the eardrum. He places packing in the middle ear to support the graft, if necessary, and either lays the graft on top of the eardrum or beneath it. The provider repositions the skin in the ear canal and packs the canal to hold the skin in place. He sutures any exterior incisions closed and applies a dressing.

69631 - Nat'l Avg. $905.49 RVU 25.09
69145 - Nat'l Avg. $257.68 RVU 7.14
69610 - Nat'l Avg. $29738 RVU 8.24