such78
Expert
Post op dx: left conductive hearing loss with otosclerosis
Procedure performed:
1. Left tympanoplasty
2. Ossicular chain reconstruction
3. Stapedectomy
A posterior tympanomeatal incision was made using the angled Beaver blade, and then the flap was elevated with a round canal knife and middle ear cavity was entered. The middle ear is clear and the chorda tympani nerve was identified. Following that, the ossicular chain was tested using curved Rosen needle. The patient has completely solid stapes footplate; and , after that, the posterior canal wall was curetted. The chorda tympani nerve was preserved. After that, the stapes was more visualized; using a straight Rosen needle, a stapedotomy was performed and then the incudostapedial joint was separated with a joint knife and the stapedial ligament was then cut using the Bellucci scissors. After that, downfracture was performed using a curved Rosen. The stapes was the fracture inward. The stapes footplate was then lifted with a micro right-angle hook. Following that, a piece of perichondrial cartilage membrane was harvested using the #15 blade. The donor sites were closed using 5-0 plain gut suture. The graft was then trimmed and thinned and then placed over the oval window with the alligator. Rosen needle was used to position the perichondrial flap over the oval window. After that, a 4.25 ridig bucket handle piston was used and delivered onto the graft and the hooked to the tip of the incus and Gelfoam was used to support the reconstructed ossicular chain and the tympani membrane was returned to the original position. The ear canal was filled with bacitracin ointment followed by cotton ball. The donor site was closed with 5-0 plain gut suture.
I assigned 69632 - tympanoplasty ossicular chain reconstruction ,69660 - stapedectomy, and 21235- cartilage membrane harvest.
My question is CPT 69632 also included stapedectomy and 21235 ( the cartilage was harvested through the same incision with stapedectomy, but the surgeon mentioned the donor site was sutured)qualified to code separately? or just report 69632 for this performance?
Thank you for advice.
Procedure performed:
1. Left tympanoplasty
2. Ossicular chain reconstruction
3. Stapedectomy
A posterior tympanomeatal incision was made using the angled Beaver blade, and then the flap was elevated with a round canal knife and middle ear cavity was entered. The middle ear is clear and the chorda tympani nerve was identified. Following that, the ossicular chain was tested using curved Rosen needle. The patient has completely solid stapes footplate; and , after that, the posterior canal wall was curetted. The chorda tympani nerve was preserved. After that, the stapes was more visualized; using a straight Rosen needle, a stapedotomy was performed and then the incudostapedial joint was separated with a joint knife and the stapedial ligament was then cut using the Bellucci scissors. After that, downfracture was performed using a curved Rosen. The stapes was the fracture inward. The stapes footplate was then lifted with a micro right-angle hook. Following that, a piece of perichondrial cartilage membrane was harvested using the #15 blade. The donor sites were closed using 5-0 plain gut suture. The graft was then trimmed and thinned and then placed over the oval window with the alligator. Rosen needle was used to position the perichondrial flap over the oval window. After that, a 4.25 ridig bucket handle piston was used and delivered onto the graft and the hooked to the tip of the incus and Gelfoam was used to support the reconstructed ossicular chain and the tympani membrane was returned to the original position. The ear canal was filled with bacitracin ointment followed by cotton ball. The donor site was closed with 5-0 plain gut suture.
I assigned 69632 - tympanoplasty ossicular chain reconstruction ,69660 - stapedectomy, and 21235- cartilage membrane harvest.
My question is CPT 69632 also included stapedectomy and 21235 ( the cartilage was harvested through the same incision with stapedectomy, but the surgeon mentioned the donor site was sutured)qualified to code separately? or just report 69632 for this performance?
Thank you for advice.