AN2114

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I wanted to get an opinion on this op report. I know there is no code for ossicular chain reconstruction or excision of canal cholesteatoma and the closest code would be 69632. The doctor did not repair the tympanic membrane but because of the reconstruction and removal of cholesteatoma, can I still use 69632 or should I do 69632-52?

Procedures: Left middle ear exploration with ossicular chain reconstruction, excision of canal cholesteatoma.

Patient was taken to surgery anesthetized under general anesthesia properly prepped and draped. Attention was first drawn to the left ear with the operative microscope. The ear was brought into view and the external canal and tympanic membrane was focused and upon there was noted to be a small canal cholesteatoma, and a well healed tympanic membrane with no evidence of perforation. The bony annular rim was infiltrated with a solution of 1% Xylocaine w/1:100k epinephrine. Attention was then drawn to the middle ear, a tympanic membrane flap was elevated and the middle ear was entered carefully taking care to not cause any perforation in the tympanic membrane. There was silastic sheeting that was encountered in the middle ear cleft, this was removed to reveal healthy middle ear mucosa without any evidence of residual cholesteatoma. The stapes footplate was then identified and a Dorhaufer prosthesis was trimmed to 3 mm in size and placed over the stapes footplate and manipulated into a good position. The tympanomeatal flap was then laid back down and the prosthesis was found to be in good position not causing tenting of the TM. The middle ear space was then packed with ciprodex soaked gelfoam. Next attention was turned to the canal cholesteatoma, this was removed using suction and instrumentation. Next the tympanomeatal flap was laid back making sure the edges were unfurled and in good position. The ear canal was then packed with ciprodex soaked gelfoam and bacitracin ointment. A glasscock dressing was placed and he was then turned back to anesthesia where he was extubated and taken to recovery in satisfactory condition.
 
Hello, Sorry I am late with a response, have not been on Forum for a while. I would use CPT 69633, remember, a Dorhaufer Prosthesis is considered a PORP and that is the surgeons primary goal is to restore the continuity of the ossicular chain, they are doing so by reconstructing with a synthetic prosthesis. I would also include CPT 69145 - Excision soft tissue lesion, EAC for the removal of the cholesteatoma, it is a separate procedure and there are no CCI edits between 69145 and 69633, consider Modifier 59 or XU with 69145.

Hope this helps!

Jennifer
Coding Analyst
Previous ENT experience - 27 years
 
Hello, Sorry I am late with a response, have not been on Forum for a while. I would use CPT 69633, remember, a Dorhaufer Prosthesis is considered a PORP and that is the surgeons primary goal is to restore the continuity of the ossicular chain, they are doing so by reconstructing with a synthetic prosthesis. I would also include CPT 69145 - Excision soft tissue lesion, EAC for the removal of the cholesteatoma, it is a separate procedure and there are no CCI edits between 69145 and 69633, consider Modifier 59 or XU with 69145.

Hope this helps!

Jennifer
Coding Analyst
Previous ENT experience - 27 years
Thank you! Since code 69633 includes a tympanoplasty as well do you think I should use modifier 52 or is there enough information that I do not need the reduced services modifier?
 
Thank you! Since code 69633 includes a tympanoplasty as well do you think I should use modifier 52 or is there enough information that I do not need the reduced services modifier?

Here's your answer, this was found thru the AAPC Coder, no Mod. 52:

Question: The provider enters the middle ear through a canal skin flap, removes disease and uses PORP for lateral chain reconstruction. He does not use a graft for the tympanic membrane. Should I still code a tympanoplasty?

Answer: Yes, although the operation required no tympanic membrane repair, you can still code a tympanoplasty. The abbreviation PORP stands for partial ossicular replacement prosthesis insertion and refers to using a prosthesis to repair a portion of the patient's ossicles, or middle ear bones. Code a tympanoplasty with ossicle repair requiring prosthesis insertion with 69633, Tympanoplasty without mastoidectomy, including canalplasty, atticotomy and or middle ear surgery, initial or revision; with ossicular chain reconstruction and synthetic prosthesis, e.g., partial ossicular replacement prosthesis, or PORP, total ossicular replacement prosthesis, or TORP.

If the provider had been able to repair the ossicles without inserting a prosthesis, you would instead report 69632.

Hope all is well with you and your family, stay safe, stay well! :)

Jennifer
Coding Anayst
 
Here's your answer, this was found thru the AAPC Coder, no Mod. 52:

Question: The provider enters the middle ear through a canal skin flap, removes disease and uses PORP for lateral chain reconstruction. He does not use a graft for the tympanic membrane. Should I still code a tympanoplasty?

Answer: Yes, although the operation required no tympanic membrane repair, you can still code a tympanoplasty. The abbreviation PORP stands for partial ossicular replacement prosthesis insertion and refers to using a prosthesis to repair a portion of the patient's ossicles, or middle ear bones. Code a tympanoplasty with ossicle repair requiring prosthesis insertion with 69633, Tympanoplasty without mastoidectomy, including canalplasty, atticotomy and or middle ear surgery, initial or revision; with ossicular chain reconstruction and synthetic prosthesis, e.g., partial ossicular replacement prosthesis, or PORP, total ossicular replacement prosthesis, or TORP.

If the provider had been able to repair the ossicles without inserting a prosthesis, you would instead report 69632.

Hope all is well with you and your family, stay safe, stay well! :)

Jennifer
Coding Anayst
Thank you!!
 
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