How To Use CPT Code 69644

CPT 69644 describes a surgical procedure that 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. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 69644?

CPT 69644 is a surgical code that is used to describe a procedure involving the reconstruction of the tympanic membrane, or eardrum, to repair a perforation. This code also includes the removal of all or a portion of the mastoid, as well as the reconstruction of the posterior ear canal wall with cartilage, bone, or synthetic materials. Additionally, the procedure may involve the reconstruction of the ossicular chain, which consists of the tiny bones in the middle ear that transmit sound vibrations.

2. Official Description

The official description of CPT code 69644 is: ‘Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed canal wall, with ossicular chain reconstruction.’

3. Procedure

1. During the procedure, the surgeon creates an incision behind the ear to access the mastoid.
2. The mastoid cortex and mastoid air cells are removed to provide access to the middle ear.
3. The surgeon then enters the mastoid antrum and prepares the edges of the tympanic membrane, also known as rimming the perforation.
4. Any adhesions, skin debris, or cholesteatoma in the middle ear are removed.
5. The ossicles, or tiny bones in the middle ear, are inspected and manipulated as necessary.
6. If needed, the surgeon may replace damaged or missing ossicles with donor ossicles, sculpted bone struts, or pieces of cartilage.
7. If the posterior canal wall was removed during the procedure, it is reconstructed using cartilage, bone, or synthetic materials.
8. A fascial graft or other tissue is used to repair any tears in the tympanic membrane.
9. Packing may be placed in the middle ear to support the graft, if necessary.
10. The skin in the ear canal is repositioned and packed to hold it in place.
11. Any exterior incisions are sutured closed and a dressing is applied.

4. Qualifying circumstances

CPT 69644 is typically performed on patients who have a perforated tympanic membrane and require reconstruction. The procedure may also be necessary if the patient has mastoid disease or damage to the ossicular chain. It is important to note that this procedure should be performed by a qualified surgeon who has the necessary expertise and training in ear surgery.

5. When to use CPT code 69644

CPT code 69644 should be used when a tympanoplasty with mastoidectomy is performed, including canalplasty, middle ear surgery, tympanic membrane repair, and reconstruction of the intact or reconstructed canal wall. This code is appropriate when the procedure involves the reconstruction of the ossicular chain as well.

6. Documentation requirements

To support a claim for CPT 69644, the surgeon must document the following information:

• Patient’s diagnosis and the need for tympanoplasty with mastoidectomy
• Details of the procedure performed, including the specific techniques used for canalplasty, middle ear surgery, tympanic membrane repair, and reconstruction of the canal wall
• Date of the procedure
• Start and end time of the procedure
• Any complications or unexpected findings during the procedure
• Details of the reconstruction of the ossicular chain, if applicable
• Any additional procedures performed during the same surgical session
• Signature of the surgeon performing the procedure

7. Billing guidelines

When billing for CPT 69644, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The surgeon should document the reconstruction of the intact or reconstructed canal wall and the reconstruction of the ossicular chain, if applicable. It is also important to follow any additional guidelines provided by the payer or coding guidelines. It is recommended to review the specific billing guidelines for CPT 69644 to ensure accurate and appropriate coding.

8. Historical information

CPT 69644 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 to repair a perforated tympanic membrane and reconstruct the ossicular chain.
2. A surgeon performs tympanoplasty with mastoidectomy, including canalplasty and middle ear surgery, to address mastoid disease and repair a damaged tympanic membrane.
3. A patient with a history of chronic ear infections undergoes tympanoplasty with mastoidectomy to improve hearing and prevent further infections.
4. A surgeon performs tympanoplasty with mastoidectomy, including reconstruction of the intact canal wall, to repair a large perforation and restore the patient’s hearing.
5. A patient with a cholesteatoma undergoes tympanoplasty with mastoidectomy to remove the abnormal growth and reconstruct the middle ear structures.