Annette Posted Mon 28th of June, 2010 20:30:16 PM
Provider performed the following:
Left mastoid tympanoplasty with ossicular chain reconstruction
Temporalis fascia graft harvest
Silverstein permanent aeration tube intraosseous placement
Please advise on which CPT code (if any)that could be used for this surgery. Thank you!
SuperCoder Answered Tue 29th of June, 2010 05:41:03 AM
The CPT series 69610- 69646 consists of OCR codes, so it is very difficult to say without Op notes that how this OCR has been performed. I would suggest you to post the Op report.
Annette Posted Tue 29th of June, 2010 14:53:49 PM
Please find below the pertinent portion of the op note as requested. Thank you for reviewing.
A postauricular incision was made with the knife and carried down through the skin to the level of the temporalis fascia. Dissection had to be carried more superior and anterior in order to find the temporalis fascia. A temporalis fascia graft was harvested sharply, compressed beneath the Gelfoam press, and placed beneath the heat lamp to dry. Attention was then returned to the field, just posterior to the ear canal. Self-retaining retractors were placed in the wound bed. The ear canal was entered at the bony-cartilaginous junction. The ear canal was copiously irrigated with saline and suctioned dry. There was significant crusting over the remaining tympanic membrane. The microscope was then brought into position and used throughout the remainder of the procedure to facilitate precise microscopic dissection. The crusting over the tympanic membrane was gently elevated off of the remaining eardrum from a posterior to anterior direction. There was a large anterior perforation with extensive cholesteatoma. The cholesteatoma was removed and sent as specimen. It extended well into the eustachian tube. The edges of the perforation were folded under anteriorly and these were gently dissected away. There was a prominent bony overhang that limited visualization of the anterior most tympanic membrane. The skin of the anterior canal was elevated off of the bone from a medial to lateral direction. With the rotating drill under continuous irrigation, the anterior bony canal overhang was removed. Next, the anterior fibrous annulus was elevated out of the bony sulcus. A tympanomeatal flap was then fashioned with releasing incisions made at the 1 and 6 o'clock positions. The skin was gently elevated off the posterior canal wall and the middle ear space was entered by elevating the fibrous annulus out of the bony sulcus. The edges of the perforation were freshened sharply and all evident cholesteatoma was removed from the middle ear space. There was significant granulation tissue in the posterior middle ear. This was carefully dissected out of the middle ear space and removed. The previously placed ossicular prosthesis was also removed. This was a PORP, and there was no evident of remaining stapes. There was cartilage adherent to the posterior tympanic membrane. This was carefully dissected off of the tympanic membrane and later utilized. Once ensuring that there was adequate bony overhang along the posterior inferior canal, an osseous trough was drilled with the rotating drill under continuous irrigation for placement of the SPAT tube. A trough was drilled and then the middle ear space was entered. The 12 mm long tube was then placed into the trough and pulled flush against the edge of the ear canal. This remained patent and the SPAT tube was not crimped.
Next, attention was directed to the mastoid. A cortical mastoidectomy was performed with the rotating drill under continuous irrigation. The ear canal was thinned and Kerner's septum was entered to gain access to the antrum. There was minimal cholesterol granuloma in the mastoid air cells, but no evidence of cholesteatoma. Dissection in the antrum reached to the level of the body of the incus.
Next, attention was again directed to the middle ear space. The prosthesis sizers were utilized to find the correct length of the prosthesis. It measured 5-mm in length. The Grace medical prosthesis was shortened to 5 mm and then cut. It was then glued to the previously preserved cartilage with Dermabond. This was allowed to dry. The middle ear space was then packed with Ciprodex soaked Gelfoam. The fascia graft was trimmed to size and then placed in the middle ear medial to the perforation. Anteriorly, it was pulled through the annulus and secured with the fibrous annulus. The skin of the anterior canal was then replaced over the bony canal wall. The fascia graft was tucked beneath the malleus remnant superiorly and beneath the remaining tympanic membrane circumferentially. Next, the ossicular prosthesis was then placed in the middle ear over the least sclerotic part of the footplate and angled anteriorly. The tympanomeatal flap was replaced in it's normal anatomic position of the posterior bony canal wall. A standard rosebud dressing fashioned with Bactroban coated polyester strips and Ciprodex soaked Gelfoam. As the flap was placed over the posterior canal, a slit was made in the flap so that the flap did not cover the SPAT tube. Next, the periosteal incision was closed with 3-0 runnning and interrupted Vicryl suture.
Annette M Roberts, CPC
Business Office Manager
Piedmont ENT & Related Allergy
SuperCoder Answered Wed 30th of June, 2010 06:41:10 AM
As per the Op report you can code 69637 (TORP), 69436 and 69990.