How To Use CPT Code 69642

CPT 69642 describes a surgical procedure known as tympanoplasty with mastoidectomy and ossicular chain reconstruction. This article will provide an overview of the code, including its official description, the procedure involved, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 69642?

CPT 69642 is a code used to describe a surgical procedure called tympanoplasty with mastoidectomy and ossicular chain reconstruction. This procedure involves the reconstruction of the tympanic membrane, or eardrum, to repair a perforation, as well as the removal of all or a portion of the mastoid. It may also include other surgeries of the middle ear and the reconstruction of the ossicular chain to improve conductive hearing.

2. Official Description

The official description of CPT code 69642 is: ‘Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with ossicular chain reconstruction.’

3. Procedure

1. The surgical procedure begins with the provider making an incision in the ear canal to develop a posterior tympanomeatal flap, which is then reflected forward.
2. An additional incision may be made behind the ear to access the mastoid, where the provider removes the mastoid cortex and mastoid air cells.
3. The provider enters the mastoid antrum and prepares the edges of the tympanic membrane, also known as rimming the perforation.
4. The eardrum is then reflected forward, and any adhesions, skin debris, or cholesteatoma in the middle ear are removed.
5. The provider inspects and manipulates the ossicles, sculpting and repositioning the ossicular chain as necessary.
6. If the patient’s own ossicles are not suitable, the provider may replace them with a donor ossicle, a sculpted bone strut, or a piece of cartilage.
7. If needed, the provider may also reconstruct the ear canal.
8. A graft, such as a fascial graft, is used to repair any tears in the eardrum, and packing may be placed in the middle ear to support the graft.
9. The provider repositions the skin in the ear canal and closes any exterior incisions with sutures.
10. A dressing is applied to complete the procedure.

4. Qualifying circumstances

CPT 69642 is typically performed on patients with a perforated tympanic membrane and mastoid disease that requires surgical intervention. The procedure is performed by a qualified healthcare professional and may involve the reconstruction of the ossicular chain. It is important to note that this procedure is specific to the repair of the tympanic membrane and mastoid, and other conditions may require different codes.

5. When to use CPT code 69642

CPT code 69642 should be used when a tympanoplasty with mastoidectomy and ossicular chain reconstruction is performed. This code is appropriate when the provider performs all the necessary steps of the procedure, including the reconstruction of the tympanic membrane, removal of the mastoid, and reconstruction of the ossicular chain. It is important to review the documentation and ensure that all components of the procedure are performed before reporting this code.

6. Documentation requirements

To support a claim for CPT 69642, the healthcare professional must document the following information:

• Patient’s diagnosis indicating the need for tympanoplasty with mastoidectomy and ossicular chain reconstruction
• Details of the procedure performed, including the specific steps taken and any additional surgeries or reconstructions
• Date of the procedure
• Start and end time of the procedure
• Any complications or unexpected findings during the procedure
• Post-operative care instructions and follow-up plans
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT 69642, it is important to ensure that the procedure performed meets the criteria outlined in the code description. The provider should be qualified to perform the procedure, and all necessary components, such as tympanoplasty, mastoidectomy, and ossicular chain reconstruction, should be included. It is also important to follow any specific guidelines or requirements from the payer regarding documentation and coding for this procedure.

8. Historical information

CPT 69642 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient undergoes tympanoplasty with mastoidectomy and ossicular chain reconstruction to repair a perforated tympanic membrane and remove mastoid disease.
2. A qualified healthcare professional performs tympanoplasty with mastoidectomy and ossicular chain reconstruction on a patient with chronic ear infections and conductive hearing loss.
3. A provider performs tympanoplasty with mastoidectomy and ossicular chain reconstruction to repair a traumatic injury to the ear and restore hearing function.
4. A patient with cholesteatoma undergoes tympanoplasty with mastoidectomy and ossicular chain reconstruction to remove the abnormal growth and reconstruct the damaged structures.
5. Tympanoplasty with mastoidectomy and ossicular chain reconstruction is performed on a patient with recurrent ear infections and persistent drainage.