2025 CPT code 69635

Tympanoplasty with antrotomy or mastoidotomy, without ossicular chain reconstruction.

Consult the official CPT manual and relevant payer guidelines for the most up-to-date coding instructions.

Modifiers may be applicable depending on the circumstances of the surgery.For example, modifier -51 may be used for multiple procedures, and -59 may be used for distinct procedural services.

Medical necessity is established by documentation of a perforated eardrum and/or chronic middle ear infection unresponsive to medical management.The procedure is considered medically necessary when less invasive treatments fail to resolve the patient's condition and risk of complications.

The otolaryngologist performs the procedure under appropriate anesthesia.Responsibilities include creating the incision, accessing the mastoid, removing diseased tissue, repairing the tympanic membrane, and closing the incision.

IMPORTANT Codes 69636 and 69637 are similar but include ossicular chain reconstruction. Codes 69641-69646 are also similar, differing primarily in whether a mastoidectomy is performed and whether the posterior canal wall is preserved or reconstructed.

In simple words: This surgery repairs a hole in the eardrum and removes some bone behind the ear to treat a long-term infection. It may also involve repairing the ear canal and other parts of the middle ear.This does not include replacing any small bones in the ear.

This procedure involves the reconstruction of the tympanic membrane (eardrum) to repair a perforation and the removal of all or part of the mastoid bone to address chronic infection.It may include canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair.Ossicular chain reconstruction is not performed.

Example 1: A patient presents with a chronic ear infection and a perforated eardrum.The surgeon performs a tympanoplasty with mastoidotomy to repair the perforation and address the infection, without reconstructing the ossicular chain., A patient has undergone previous ear surgery and now requires revision surgery due to recurrent infection and perforation. The surgeon performs a revision tympanoplasty with antrotomy, employing 69635., A patient with cholesteatoma (a benign growth in the middle ear) requires surgery to remove the growth and repair the eardrum. The surgeon uses 69635 given that no ossicular chain reconstruction is necessary.

Detailed operative notes describing the approach, extent of mastoid involvement, repair of the tympanic membrane, and any additional procedures performed (canaloplasty, atticotomy, etc.).Preoperative and postoperative imaging (CT scan) may also be necessary to document the condition and the outcome of the surgery.Medical records documenting the diagnosis and the necessity of the procedure are crucial.

** This code should only be used when ossicular chain reconstruction is not performed.If ossicular chain reconstruction is necessary, use codes 69636 or 69637. Accurate coding requires careful review of the operative report to determine the exact nature and extent of the procedure.

  • Revenue Code: P5E (AMBULATORY PROCEDURES - OTHER)
  • RVU: Refer to the most up-to-date Relative Value Units (RVUs) from CMS or other relevant payer resources.
  • Global Days : The global surgical period will vary depending on payer policies and the specifics of the procedure.Consult payer guidelines for accurate information.
  • Payment Status: Active
  • Modifier TC rule: A Technical Component (TC) modifier is not applicable to this code.
  • Fee Schedule : Historical fee schedule data can be obtained from various sources, such as the AMA, CMS, and private payer websites.This data is subject to frequent change.
  • Specialties:Otolaryngology
  • Place of Service:Ambulatory Surgical Center, Hospital Outpatient, Office
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