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Tympanoplasty w/Mastoidectomy w/OssicularChain Reconstruction...Graft Bundling

Camille Posted Wed 04th of December, 2019 21:53:20 PM
CPT 69644-LT, 15733, 21235. Taken from the Op Note: "The postauricular area was injected with 1% lidocaine and 1:100,000 epinephrine, as was the ear canal after it was irrigated with saline. A postauricular incision was made and carried down to the mastoid periosteum. The incision was extended superiorly until and anteriorly based temporalis myofascial flap with the pedicle intact could be elevated. The skin was then entered and the mastoid cavity and open. This gave visibility of a very high facial ridge and an eroded external auditory canal for 80% of its length. I made the decision to canal wall down mastoidectomy at this point. The tympanomeatal flap was elevated protecting as much skin as possible as ear canal was completely taken down and the mastoid cavity was refined into a conical shape. The tympanic annulus was clearly visualized. There was atelectasis of the tympanic membrane with a type IV mechanism on the oval window. The tympanic membrane was very carefully elevated leaving the tympanic membrane superiorly and the dissection in the footplate was intact and thinned. There is erosion from the cholesteatoma into the basal turn of the cochlea which was not complete but it was blue lining the basal turn. The facial nerve was dehiscent for 3 mm and tympanic segment on the side of the stapes footplate. This is irrigated with saline and there is no further cholesteatoma noted. There is a 1 x 3 mm area of exposed dura with no residual matrix on that area once elevated. A wide meatoplasty was created removing 1.5 cm of cartilage. The perichondrium was elevated and pressed for later tympanoplasty. The cartilage was fashioned to be the diameter of the tympanic annulus. It was cut to 0.4 mm in thickness. A Dornhoffer total prosthesis with a fixed footplate shoe was sized to 2.6 mm in height and placed on the stapes footplate. The perichondrium was placed in underlay technique overlapping the vertical and tympanic segments of the facial nerve. Care was taken not to bury any cholesteatoma matrix. The temporalis myofascial flap was then rotated to cover the tegmen and to cover the defect in the tegmen bone protecting the exposed dura. The tympanomeatal flap was then laid down over the grafted material. This was packed laterally with Bactroban ointment. The meatoplasty was packed with quarter inch Nu Gauze coated in Bactroban ointment." QUESTION #1: May I code 15733? It seems to be included in the work for CPT 69644. QUESTION #2: May I code also 21235? It was not obtained thru a separate incision. Thank you, kindly!
SuperCoder Answered Thu 05th of December, 2019 09:13:55 AM

Hi,

Thanks for your question.

The grafts are not separately payable unless it occurs on the other side from the tympanoplasty with mastoidectomy. Tympanic repair by definition involves some form of graft. Therefore, grafts performed in conjunction with a tympanoplasty are usually not separately payable.

You can also refer to below mentioned article for the reference:

https://www.supercoder.com/coding-newsletters/my-otolaryngology-coding-alert/reader-question-check-location-before-coding-graft-during-tympanomastoidectomy-141597-article

Hope this helps.

Thanks.

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