2025 CPT code 69637

Tympanoplasty with antrotomy or mastoidotomy, including ossicular chain reconstruction and synthetic prosthesis (PORP or TORP).

Follow current CPT coding guidelines and payer specific requirements for accurate billing.Modifiers may be required depending on the specific circumstances.

Modifiers may be applicable, such as 50 (bilateral procedure), 51 (multiple procedures), or others depending on the circumstances of the case and payer requirements.

Medical necessity is established by the presence of a persistent conductive hearing loss secondary to a perforated tympanic membrane and/or ossicular chain disruption.This is usually documented through audiometry and imaging.

The otolaryngologist performs the entire procedure, including pre-operative evaluation, surgical intervention, and post-operative care.

IMPORTANT Related codes include 69636 (without synthetic prosthesis), 69642, 69644, and 69646 (for different approaches and canal wall status).

In simple words: This ear surgery repairs a hole in the eardrum and rebuilds tiny bones in the middle ear using artificial parts to improve hearing. It may also involve removing part of the mastoid bone behind the ear.

This procedure involves reconstructing the tympanic membrane (eardrum) to repair a perforation and reconstructing the ossicular chain using synthetic prostheses (PORP or TORP) to improve conductive hearing.It also includes all or partial removal of the mastoid.Additional procedures may include ear canal reconstruction, tympanic attic incision, and other middle ear surgeries.

Example 1: A patient presents with chronic otitis media with cholesteatoma and a perforated tympanic membrane.The surgeon performs a tympanoplasty with mastoidectomy, including ossicular chain reconstruction using a TORP., A patient with a history of trauma resulting in ossicular disruption and a tympanic membrane perforation undergoes a tympanoplasty with antrotomy and ossicular reconstruction using a PORP., A patient with a previous failed tympanoplasty requiring revision surgery and ossicular chain reconstruction using a synthetic prosthesis undergoes this procedure.

Pre-operative assessment including audiometry, imaging (CT scan), and relevant history. Operative report detailing the approach (e.g., transcanal or postauricular), extent of mastoid surgery, type of prosthesis used (PORP or TORP), and tissue grafts. Post-operative imaging and audiometry.

** This code encompasses a range of surgical techniques and may include additional procedures not specifically mentioned. Proper documentation is crucial for accurate coding and reimbursement. Always refer to the most current CPT coding guidelines and payer-specific instructions.

  • Revenue Code: P5E (AMBULATORY PROCEDURES - OTHER)
  • RVU: Refer to CMS fee schedules for current RVU values.These vary by geographic location and facility type.
  • Global Days : Global period varies depending on payer and may include pre and post operative care.Consult specific payer guidelines.
  • Payment Status: Active
  • Modifier TC rule: The Technical Component (TC) modifier is not typically applicable to this code as it represents the entire procedure.Refer to payer specific instructions.
  • Fee Schedule : Historical fee schedules are not included here, but can be found in previous years' CMS fee schedules.
  • Specialties:Otolaryngology
  • Place of Service:Ambulatory Surgical Center, Hospital Outpatient Department
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