Otolaryngology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the
answer.
Question: Should we bill 15732 (Muscle, myocutaneous, or fasciocutaneous flap; head and neck) with tympanoplasty codes 69610-69646? I recently attended a seminar in which we were told this billing is acceptable. Our surgeons are unsure whether this would be an appropriate coding combination because the graft is taken from the same site/incision, not a separate site/incision. Pennsylvania Subscriber Answer: The tympanoplasty codes include the graft when performed on the same side. If the graft requires a separate excision, you may report the tympanoplasty and the graft. For instance, an otolaryngologist repairs a perforation after a prior failure and has to use temporalis fascia from the opposite side. Report 69631 (Tympanoplasty without mastoidectomy [including canaloplasty, atticotomy and/or middle ear surgery], initial or revision; without ossicular chain reconstruction]) and 15770 (Graft; derma-fat-fascia) appended with modifier -59 (Distinct procedural service) to indicate the graft was a separate procedure. Document the unusual circumstances, such as prior surgery, that made the graft a distinct service.