CPT® Code 0583T

Official Description

Tympanostomy (requiring insertion of ventilating tube), using an automated tube delivery system, iontophoresis local anesthesia

Common Language Description

Tympanostomy is a surgical procedure that involves the insertion of a small tube into the ear to alleviate conditions such as otitis media, which is characterized by the accumulation of fluid in the middle ear. This condition is particularly common in children, with nearly all experiencing otitis media with effusion before the age of four. The presence of thick, sticky fluid in the middle ear can lead to various complications, including ear pain, hearing loss, difficulties in sleeping, delayed speech development, and balance issues. Traditionally, tympanostomy tubes are placed under general anesthesia in a controlled operating room environment. However, the use of general anesthesia, especially in young children, raises concerns regarding potential adverse effects on neurological, cognitive, and developmental outcomes, as well as increased healthcare resource utilization, caregiver burden, and anxiety for both the child and the family. Recent advancements in technology, such as the TULA System, have introduced a more efficient method for performing tympanostomy. This system utilizes an automated tube delivery mechanism and allows for the procedure to be conducted under local anesthesia in an outpatient setting, thereby minimizing the risks associated with general anesthesia. The TULA Iontophoresis System is a key component of this approach, featuring a headset with earplugs that contain electrodes connected to a control unit. This setup delivers local anesthesia to the tympanic membrane over a short period, utilizing iontophoresis—a technique that employs a low-level electrical current to facilitate the transdermal movement of charged drug molecules. Following the administration of local anesthesia, the TULA Tube Delivery System enables the physician to make a precise incision in the tympanic membrane and swiftly insert the preloaded tube in a single automated motion, streamlining the procedure and enhancing patient comfort.

1. Indications

The tympanostomy procedure is indicated for the treatment of specific conditions related to the middle ear, particularly:

Otitis Media with Effusion - This condition involves the accumulation of fluid in the middle ear, which can lead to hearing loss and other complications.
Recurrent Otitis Media - Patients who experience multiple episodes of otitis media may require tympanostomy to prevent further occurrences and associated complications.
Chronic Ear Infections - Persistent infections in the middle ear that do not respond to medical management may necessitate the placement of tympanostomy tubes to facilitate drainage and ventilation.

2. Procedure

The tympanostomy procedure using the TULA System involves several key steps that ensure effective placement of the ventilating tube:

Preparation of the Patient - The patient is positioned comfortably, and the TULA Iontophoresis System is set up. The headset with earplugs is placed on the patient, ensuring proper contact with the ear to deliver local anesthesia effectively.
Administration of Local Anesthesia - The control unit of the TULA Iontophoresis System is activated to deliver local anesthesia to the tympanic membrane. This process utilizes iontophoresis, which applies a low-level electrical current to facilitate the transdermal movement of the anesthetic drug, ensuring that the area is adequately numbed for the procedure.
Incision in the Tympanic Membrane - Once the local anesthesia has taken effect, the physician makes a small incision in the tympanic membrane. This step is crucial for accessing the middle ear and allows for the insertion of the tympanostomy tube.
Insertion of the Tympanostomy Tube - The TULA Tube Delivery System is then employed to insert the preloaded tympanostomy tube into the incision. This automated process allows for a swift and precise placement of the tube, minimizing trauma to the surrounding tissues.
Completion of the Procedure - After the tube is successfully placed, the physician ensures that the incision is secure and that the tube is functioning correctly. The patient is then monitored briefly before discharge.

3. Post-Procedure

Following the tympanostomy procedure, patients are typically monitored for a short period to ensure there are no immediate complications. Post-procedure care may include instructions on keeping the ear dry and avoiding water exposure for a specified duration. Patients may also be advised on signs of infection or complications to watch for, such as increased pain, discharge, or fever. Follow-up appointments are usually scheduled to assess the function of the tympanostomy tube and the overall health of the ear, ensuring that any issues are addressed promptly.

Short Descr	TMPST AUTO TUBE DLVR SYS
Medium Descr	TYMPANOSTOMY AUTOMATED TUBE DELIVERY SYSTEM
Long Descr	Tympanostomy (requiring insertion of ventilating tube), using an automated tube delivery system, iontophoresis local anesthesia
Status Code	Carriers Price the Code
Global Days	YYY - Carrier Determines Whether Global Concept Applies
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator	Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate.
Berenson-Eggers TOS (BETOS)	none
MUE	2