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mastoidectomy & tympanoplasty w/ossicular chain reconstruction w/PORP prosthesis

Bill Posted Tue 23rd of September, 2014 09:49:16 AM

Can you please tell me if procedure code "69644" would be appropriate for mastoidectomy and tympanoplasty with ossicular chain reconstruction if a POPRP hydroxyapatite prosthesis was drilled also?

thank you

SuperCoder Answered Wed 24th of September, 2014 08:29:07 AM

Thank you for your question. Below is the Clinical Summary of code 69644. The code would be appropriate for your procedure.

Clinical Responsibility

During this procedure, the otolaryngologist reconstructs the tympanic membrane (eardrum) to fix a perforation and removes all or a portion of the mastoid. He may also reconstruct the posterior ear canal wall with cartilage, bone or synthetic materials and perform an ossicular chain reconstruction. This might involve reconstruction of the ear canal, tympanic membrane repair and/or other surgeries of the middle ear.

The otolaryngologist creates a postauricular incision to access the mastoid and removes the mastoid cortex and mastoid air cells. He enters the mastoid antrum 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, then sculpts and repositions the ossicular chain. Depending on the state of the patient's own ossicles, the surgeon might replace them with a donor ossicle, a sculpted bone strut or piece of cartilage. If he removed the posterior canal wall during access of the middle ear, the surgeon uses cartilage, bone or synthetic materials such as hydroxyapatite to reconstruct the wall. If needed, the physician 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 surgeon 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.

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