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Lt Modified Radical Mastoidectomy with Lt Tympanoplasty w/PORP

Camille Posted Fri 24th of January, 2020 15:28:39 PM
I don't find one CPT that includes both a modified radical mastoidectomy with tympanoplasty w/ossicular chain reconstruction and synthetic prosthesis (PORP). Therefore, am i coding correctly if i bill both 69505-LT & 69633-LT? Thank you very much!
SuperCoder Answered Mon 27th of January, 2020 07:02:27 AM

Hi Camille,

Tympanoplasty and mastoidectomy are two major procedures performed. In CPT codes 69505 and 69633, both the procedures are performed separately. However, Tympanoplasty with mastoidectomy is covered in the CPT code 69646, with ossicular chain reconstruction. Although, there is no inclusion for PORP in CPT 69646.

Since, there is one code available for both the major portion of the procedures i.e. 69646, then to avoid possible denial, it would be appropriate not to bill two separate codes i.e. 69505 and 69633.

Also, you can append modifier 22 (increased Procedural Services) along with modifier LT to CPT 69646 {Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, with ossicular chain reconstruction}, to avail the extra amount for the PORP service.

It is suggested to include the operative notes or other relevant documentation to strengthen the claim to support the use of modifier 22.

Hope this helps!

Camille Posted Mon 27th of January, 2020 14:14:44 PM
Thank you for your response. I am an ASC and cannot use modifier -22. All implants are inclusive in our CPT (no separate implant billing in our contracts). Will you please review my recent and similar "Ask an Expert" question and your response (which I cut and pasted below)? One code did contain the major component/portion of both the procedures but i was advised to use two CPT codes. Will you please compare with your above response and clarify the difference? Thank you kindly! ...................................................................................................................................................................................................................................................Camille Posted Mon 30th of December, 2019 17:25:08 PM Provider performs revision of complete mastoidectomy, ossicular chain reconstruction and synthetic prosthesis PORP, and a revision tympanoplasty. Does CPT 69637 capture all 3 of these components correctly? Thank you very much! SuperCoder Answered Tue 31st of December, 2019 06:11:05 AM Hello Camille, Thank you for your question CPT® code 69637 covers all the components, i.e. Tympanoplasty, ossicular chain reconstruction and synthetic prosthesis (PORP) and mastoidectomy, but it does not indicate the revision part. More appropriate code for the above-mentioned scenario will be CPT® code 69633 (Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis [PORP], total ossicular replacement prosthesis [TORP]) and CPT® code 69604 (Revision mastoidectomy; resulting in tympanoplasty). The above codes indicate the revision mastoidectomy and revision tympanoplasty. Note: Append modifier 52 (Reduced Services) along with CPT® code 69604, as the tympanoplasty procedure has already been covered up in CPT® code 69633. Hope that helps! Thanks
SuperCoder Answered Tue 28th of January, 2020 09:08:39 AM

Hi Camille,

Hope you are keeping well.

In the previous question, for CPT 69637, Tympanoplasty with antrotomy or mastoidotomy has been performed but not the revision. So, for revision a different code had been suggested.

Since, ASC setting does not allow the use of modifier 22, then you can go with your selected two different sets of codes, i.e. 69505 and 69633. Whereas, in CPT 69633, procedure does not include removal of the mastoid cavity, so CPT 69505 can be coded.

Hope this help!

Camille Posted Tue 28th of January, 2020 12:58:30 PM
Thank you!
SuperCoder Answered Tue 28th of January, 2020 23:38:25 PM

Thank you, happy to help.

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