Wiki Post-mastoidectomy Thiersch Grafting procedure 69670 vs 15120- 15158 range vs 17999

jfolz

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Hi all,

I code for an outpatient hospital surgery department. We have a new physician that is doing some more involved ENT procedures than we have previously seen. I was wondering if anyone had any information on the correct CPT to cover split-thickness skin grafting from the upper arm to the (previously created, wall down) mastoidectomy cavity. This is not due to CSF leakage or infection, it is mentioned by the surgeon that it was to speed the healing process and to reduce the possibility of infection of the cavity by reducing the healing time.

The surgeon suggested CPT range of 15120-58. I don't necessarily disagree but I was looking at 69670 also, also trying to gain a better understanding of that code.

The description of 69670 is, " Through a postauricular incision, the physician accesses the mastoid cavity of a previous mastoidectomy. Any remaining mastoid disease is removed. To lessen the size of a large mastoid cavity or to stop a CSF leak, the cavity is obliterated with a rotation flap of fascia or muscle and/ or free fat graft and skin. The flap is sutured into place and the incision is sutured."

We really aren't lessening the size of the cavity or "obliterating" anything but we are grafting a free skin graft to that previously created cavity, which will reduce the amount of space that will need to heal... so the intent is a little off but the procedure is pretty close...

For now, I think I am going to go with the 15120 CPT... but my question on this CPT is, from reading the code I cannot tell if this includes only grafting to the external ear or if the internal structures are included as well?

If 15120 is only for the external ear structure, I think I might be looking at an unlisted 17999.

Anyone have any suggestions?
Thanks in advance!
 
Update

I did wind up going with 15120. We use the 3M encoder and I consulted with the Nosology service that they offer. The rep I was in contact with couldn't find anything in the CPT guidelines or updates specifically directing us to any code but also felt that after reading the Op Note, 15120 did describe the procedure that took place adequately.
 
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