Tymp Coding and Grafts


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First time posting to this site, so bear with me.
New doctor to the practice states that a separate incision is always done for grafts (15770) when codes 69631-69646 are performed, I was always taught if it was on the same side then it could not be billed for that it was included in the 69631-69646 codes, only if it was on the opposite side, separate incision, etc.. could we bill for it with modifier 59, Has something changed ? Did I miss the boat ?


Local Chapter Officer
Victoria, TX
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Harvesting of the graft, whether through the same or separate incisions, used to be included in codes 69631 through 69646. However, the AMA issued further guidance in 2012 stating that a graft harvested through a separate incision is separately reportable. :See CPT Assistant article below

CPT Assistant Archives - THEN and NOW: Temporalis Fascial Graft (December 2012)

THEN and NOW: Temporalis Fascial Graft
The March 2007 (p 9) and August 2008 (p 4) editions of the CPT Assistant discussed the reporting of code 69631, Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction, with harvesting of a temporalis fascial graft through the same or separate incision. This information has been updated and the following clarification is provided in this Then and Now.


The March 2007 CPT Assistant indicated that code 69631 includes the work of harvesting the graft material. Therefore, code 69631 should be reported regardless of whether the graft was harvested through the same incision or a separate incision. Therefore, it would not be appropriate to report a separate code for the fascial graft.


The August 2008 CPT Assistant discussed the repair of a tympanic membrane perforation, wherein a graft is harvested from either the temporalis fascia or other locations (ie, vein, periosteum, or conchal cartilage perichondrium). Occasionally, a graft is used from material other than autogenous tissue. If the temporalis fascia graft is harvested through a separate donor incision, the harvesting should be reported separately from the tympanoplasty.

The August 2008 coding guidance supersedes the March 2007 CPT Assistant instruction, as it agrees with the general CPT convention that graft harvest is reported separately under these conditions: (1) when obtained through a different incision; and (2) when the descriptor language does not specify graft harvest as integral to a service. ♦

THEN and NOW: Temporalis Fascial Graft. CPT® Assitant. 2012; December 2012 page 11​

Hope that helps!
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Would you be able to provide me with a link to the official AMA documentation for this from 2008? I am constantly running into this problem and would like the official guidelines to send with appeals but am unable to find them. When I searched your sources I was sent to Find A Code's newsletters, but I want the AMA documentation.