ENT - Ear Surgery (Tympanoplasty & Mastoidectomy)

ENT - Tympanoplasty & Mastoidectomy Hierarchy

📋 The Rule (Quick Summary)

The Combo Rule: Never bill a Tympanoplasty (69631) and a Mastoidectomy (69502) separately if they are done in the same session. There is a “Combo Code” that covers both.

---

💰 CPT Selection Logic

(Start at the bottom and work up - choose the “biggest” surgery)

1. Tympanoplasty Only (Eardrum Repair):

• 69631: Repair of eardrum (Myringoplasty) + inspection of ossicles.
• 69632: Repair + Ossicular Chain Reconstruction (OCR) (Fixing the bones).

2. Mastoidectomy Only (Drilling bone behind ear):

• 69501: Simple (Complete).
• 69502: Modified Radical (Removes disease, preserves hearing structures).
• 69511: Radical (Removes everything).

3. The COMBO Codes (Tymp + Mastoid):

• 69641: Tympanoplasty + Mastoidectomy (Intact wall).
• 69642: Tympanoplasty + Mastoidectomy + OCR (Bone repair).
• 69643: Tympanoplasty + Mastoidectomy (Wall down/Radical).

⚠️ Modifier Watch

• -50 (Bilateral): Allowed (150% pay).
• -59: Only use if operating on the other ear (use -RT/-LT instead).
• Microscope: Do not bill 69990 (Microscope). It is bundled into all ear surgeries.

---

🚨 Documentation Alerts (Query Triggers)

1. “Canal Wall Up vs. Down”: This changes the code significantly (69641 vs 69643). Look for “posterior canal wall was preserved” (Up) or “taken down” (Down).
2. OCR (Ossicular Chain Reconstruction): Did they replace a bone with a TORP/PORP prosthesis? If yes, you graduate to the higher code (69632 or 69642).