2025 CPT code 69642
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Auditory System Surgery Feed
Tympanoplasty with mastoidectomy, including canalplasty, middle ear surgery, and tympanic membrane repair; with ossicular chain reconstruction.
Modifiers may be applicable depending on the circumstances of the service.For example, modifier -50 (bilateral procedure) could be used if the procedure is performed on both ears.Other modifiers might be needed based on NCCI edits or payer-specific guidelines.
Medical necessity for this procedure is established when a patient presents with symptoms and findings consistent with chronic otitis media, cholesteatoma, or other conditions requiring tympanoplasty and mastoidectomy to improve hearing, prevent further complications, or address structural damage to the middle ear.The decision for surgery should be based on a thorough evaluation and clinical judgment.
The otolaryngologist (ENT surgeon) is responsible for performing the procedure. Pre-operative assessment, surgical technique, post-operative care, and patient education fall under the physician's purview.
In simple words: This surgery fixes a damaged eardrum and cleans out a bone behind the ear (the mastoid) that might be infected or have a cyst.It also repairs the tiny bones in the middle ear that help with hearing. This is usually done for chronic ear infections or growths in the ear.
This CPT code 69642 represents a combined surgical procedure involving tympanoplasty and mastoidectomy.Tympanoplasty addresses the repair or reconstruction of the tympanic membrane (eardrum) and the middle ear structures.The mastoidectomy component involves surgical access and removal of diseased tissue or bone from the mastoid process, a bony prominence behind the ear. Canalplasty, the surgical repair of the ear canal, may also be included.The procedure specifically includes ossicular chain reconstruction, which aims to restore the function of the tiny bones (ossicles) responsible for sound transmission within the middle ear. This is typically performed to address chronic ear infections, cholesteatoma (a growth of skin cells), or other conditions causing damage to the middle ear structures. The procedure may involve the use of grafts or prosthetic materials to reconstruct the eardrum or ossicles.
Example 1: A 45-year-old patient presents with chronic otitis media (middle ear infection) and a cholesteatoma (a cyst) in the mastoid.A tympanoplasty with mastoidectomy is performed to remove the infection and the cyst, repair the eardrum, and reconstruct the ossicular chain., A 60-year-old patient with a history of prior ear surgeries experiences a recurrent eardrum perforation and ossicular chain disruption.A revision tympanoplasty with mastoidectomy and ossicular chain reconstruction is performed to address the perforation and restore hearing., A 20-year-old patient suffers a significant injury to the middle ear following a traumatic event.Surgery involving tympanoplasty with mastoidectomy is indicated to repair the damage, including the eardrum and ossicular chain,and restore middle ear integrity.
Detailed history and physical examination documenting the patient's symptoms, including hearing loss, ear pain, and discharge.Pre-operative imaging (e.g., CT scan) to visualize the extent of the middle ear and mastoid involvement.Operative report detailing the surgical procedure, including specific techniques used for tympanoplasty, mastoidectomy, and ossicular chain reconstruction. Post-operative assessment of hearing and wound healing.
** The complexity of this procedure and the selection of appropriate codes necessitate a thorough understanding of surgical techniques, anatomy, and current coding guidelines.Consultation with coding and billing experts is highly recommended to ensure accurate billing practices.
- Revenue Code: P5E (AMBULATORY PROCEDURES - OTHER)
- RVU: This information is not available in the provided source.Consult the current CPT manual or other relevant payment resources for RVU data.
- Global Days : This information is not provided in the source.The global period will depend on payer policies and may vary.
- Payment Status: Active
- Modifier TC rule: The application of TC modifiers (Technical Component) depends on the specific circumstances of the procedure and payer requirements. This needs to be assessed on a case-by-case basis.
- Fee Schedule : This information is not available in the provided source.Historical fee schedule information may be found in archival CPT or payer-specific data.
- Specialties:Otolaryngology
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center, Outpatient Hospital