Manders21

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Can someone explain the difference between 69643 and 69645? What makes 69645 radical/complete? The description I read of both codes sound identical so what is the main difference to distinguish which one to use?

Here is the op report:

Attention was then turned to behind the ear were a 15 blade was used to make a superior post auricular incision 1/2 a cm behind the post auricular crease. The incision was carried down to the temporalis fascia and hemostasis was achieve with Bovie and bipolar cautery. The temporal line was then identified and a palva flap was created using the bovie. The Palva flap was raised with a lampert. The freer was used to dissect the EAC away from bone. The 6400 blade was used to make the canal incision and the 12 and 6 o'clock incisions. A penrose drain was placed to retract the ear. Perkins retractor were used to retract the ear and the flap. The tympanomeatal flap was elevated using a large weapon and a size #20 suction. A rosen needle was used to enter the middle ear. Gimmick elevator was used to free up the anulus inferiorly and more widely expose the middle ear. Granulation tissue filled the middle ear. Chorda was identified and preserved.

Attention was turned to the mastoid. The previous mastoid cavity was inspected and was filled with thick mucosa and granulation tissue. Canal wall down mastoidecotmy was performed. A size 5 cutting burr was used initially to saucerize the mastoid bowl. Then it was switched to a size 3 cutting burr to extend the cavity into the zygomatic root and take down the posterior canal wall. At this point the facial nerve was stimulated in the middle ear space and was intact. A size 2 diamond bur was used to remove the bone overlying the facial ridge and to smooth any ledges. There was purulent drainage coming from the middle ear. Remaining granulation tissue was removed from the middle ear space and the mastoid cavity. The malleus was identified and was covered in adhesions and granulation tissue. It was removed. The stapes was identified and was intact. Facial nerve was stimulated throughout the procedure and at the end and was intact. The tympanomeatal flap was then laid back down. A tympanostomy was created by extending the existing perforation. A touma tube was placed to allow drainage. The biodesign graft was then cut to size and placed under the existing TM and the over exposed bone of the bony facial ridge. The middle ear was packed with ciprodex soaked el foam.

Attention was turned to the meatoplasty. Two incision were made with a 15 blade in the EAC at 6 and 12 o'clock positions. The superior incision was above the superior crus of the helix and the bottom one was inferior to the tragus. These incisions were identified post auricularly and connected. Then using a bovie the posterior aspect of the flap was debulked. The edges of the flap were sutured to the post auricular subcutaneous tissue using 4-0 Vicryl. The EAC was packed with a pope merocel pack trimmed to size and coated in bacitracin, bacitracin ointment and a cotton ball. The post auricular incision was then closed by first approximating the subcutaneous tissue with 4-0 Vicryl and the skin was closed using 5-0 FAG suture in a running fashion. Piece of telfa was placed over the post auricular incision and a glasscock dressing was applied.
 
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such78

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Code 69643, Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed wall, without ossicular chain reconstruction, includes elements of tympanoplasty without ossicular reconstruction plus mastoidectomy that preserves the common wall between the mastoid and ear canal, or includes immediate reconstruction if the wall is taken down for removal of disease. The canal wall reconstruction is typically performed with cartilage, the harvesting of which may be reported separately if it is obtained from an incision different from that used for the primary procedure. Multiple materials may be used for this purpose, including autologous and homologous cartilage and bone, hydroxyapatite in granular cement and preformed solid forms, porous polytetrafluoroethylene-carbon filament composite, and titanium mesh.



Code 69645, Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, without ossicular chain reconstruction, includes tympanoplasty with a radical or complete mastoidectomy. Typically, the common wall between the mastoid bone and ear canal would be removed, creating a common cavity (mastoid cavity or mastoid bowl).

mastoidectomy-an operation to dissect or open the mastoid bone for exposure or removal of disease. Depending on the amount of infection or cholesteatoma present, various degrees of mastoidectomies can be performed. The common wall between the mastoid and ear canal may be removed ("canal wall down"), left intact ("canal wall up"), or taken down but reconstructed, typically with cartilage. Mastoidectomies may be performed as stand-alone operations or with tympanoplasty or other procedures.

• simple or complete mastoidectomy-the surgeon opens the mastoid, including the antrum, and removes any infection

• radical mastoidectomy-removes most of the mastoid bone and joins it to the ear canal creating a common cavity. This operation is rarely performed today. The eardrum and middle ear structures may be completely removed, sparing the stapes (the stirrup-shaped bone) if possible to help preserve some hearing.

• modified radical mastoidectomy-the common wall between the ear canal and mastoid is taken down, exteriorizing disease (typically cholesteatoma) with existing middle ear bones left in place. This is usually performed when the hearing is relatively well preserved
 
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