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69602 Revision Mast resulting Modified Rad Mastoidectomy

Camille Posted Fri 06th of March, 2020 13:52:19 PM
The description for a Revised Mastoidectomy resulting in modified radical mastoidectomy includes the development of a tympanomeatal flap which is reflected anteriorly. Instead, the surgeon did a myofascial flap reconstruction of the mastoid cavity. QUESTION: Is this separately billable (CPT 15733) or would this be considered included the procedure? Thank you! OP NOTE EXCERPT (if necessary for perspective): "A drill was then used to perform a complete mastoidectomy. The tegmen mastoideum, posterior fossa dural plate, lateral dural sinus, lateral sinus, lateral semicircular circular canal, and fallopian canal identified and preserved. A posterior tympanotomy was opened. The facial nerve was not dehiscent. At this point I made the decision to exteriorize the cholesteatoma and do a wide meatal plasty turning a temporalis myofascial flap over the area of the exposed dura. When measuring for the flap I realize that a inferiorly based trapezius flap would be much easier. This was elevated and mobilized for later reconstruction. The mastoid tip was drilled away the external auditory canal was drilled down to the level of tympanic annulus leaving the tympanic membrane intact.Next a wide meatal plasty was created. The cartilage was then saved and cut to 0.5 mm in thickness with the perichondrium being pressed for later reconstruction over the open facial recess. Cartilage was placed over the facial recess and a cup of cartilage was placed over the aditus at antrum without coming in contact with the incus. The perichondrium was overlapped over the facial ridge up to the intact tympanic membrane into the mastoid cavity. The temporalis flap was mobilized over the exposed dura knowing there was some cholesteatoma present but this was not buried. The medial plasty was sutured open after removing 1.5 cm of cartilage as stated above. This was sutured posteriorly and superiorly to keep this open."
SuperCoder Answered Mon 09th of March, 2020 04:45:38 AM

Hi Camille,

 

Thanks for your question.

 

There is no CCI edit between codes 69602 and 15733. So, these can be billed together. Tympanomeatal flap is included in code 69602 but since your physician has performed temporalis myofascial flap, code 15733 can be billed separately.

 

Please feel free to write if you have any question.

 

Thanks

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