Crystal's MCW Coder Hub🩺 CPT Code 69631 - Tympanoplasty Without Mastoidectomy
Code Description
CPT 69631 - Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision
This code represents a surgical procedure to reconstruct the tympanic membrane (eardrum) and/or repair the ossicular chain in the middle ear without removing the mastoid bone. It includes necessary steps such as canalplasty (repair of the ear canal), atticotomy (opening the attic of the middle ear), and middle ear exploration. It applies to both initial procedures and revisions.
Key Distinction:
- 69631: Tympanoplasty without mastoidectomy.
- 69633: Tympanoplasty with mastoidectomy (complete or radical).
- 69635: Tympanoplasty with ossicular chain reconstruction (without mastoidectomy).
- 69636: Tympanoplasty with ossicular chain reconstruction (with mastoidectomy).
- 69637: Tympanoplasty with stapes fixation (without mastoidectomy).
- 69638: Tympanoplasty with stapes fixation (with mastoidectomy).
Code Tree/Hierarchy
CPT Code Structure
└── Surgery (10000-69999)
└── Auditory System (69000-69979)
└── Middle Ear (69420-69667)
└── Tympanoplasty (69631-69667)
├── 69631 - Tympanoplasty without mastoidectomy
├── 69633 - Tympanoplasty with mastoidectomy
├── 69635 - Tympanoplasty with ossicular chain reconstruction (without mastoidectomy)
├── 69636 - Tympanoplasty with ossicular chain reconstruction (with mastoidectomy)
├── 69637 - Tympanoplasty with stapes fixation (without mastoidectomy)
├── 69638 - Tympanoplasty with stapes fixation (with mastoidectomy)
└── 69641-69667 - Other tympanoplasty variations
Related ICD-10-CM Diagnosis Codes
Common Primary Diagnoses
| ICD-10-CM Code | Description |
|---|---|
| H72.00 | Central perforation of tympanic membrane, unspecified ear |
| H72.01 | Central perforation of tympanic membrane, right ear |
| H72.02 | Central perforation of tympanic membrane, left ear |
| H72.03 | Central perforation of tympanic membrane, bilateral |
| H72.10 | Attic perforation of tympanic membrane, unspecified ear |
| H72.20 | Other marginal perforation of tympanic membrane, unspecified ear |
| H72.81 | Total perforation of tympanic membrane |
| H72.90 | Unspecified perforation of tympanic membrane, unspecified ear |
| H66.30 | Other chronic suppurative otitis media, unspecified ear |
| H66.90 | Otitis media, unspecified, unspecified ear |
| H90.0 | Conductive hearing loss, bilateral |
| H90.1 | Conductive hearing loss, unilateral |
| H74.31 | Acquired abnormalities of ossicles |
External Cause Codes (Reference: icd10cm_eindex_2025.pdf)
Note: Tympanoplasty is typically for chronic conditions. However, if the perforation resulted from trauma, barotrauma, or injury, external cause codes are required. Based on the uploaded External Cause Index 2025:
| Category | Code Example | Description from Index |
|---|---|---|
| Air Pressure (Barotrauma) | W94.23 | Change in air pressure, during ascent in aircraft |
| W94.31 | Change in air pressure, during descent in aircraft | |
| Contact with Object | W26.9 | Contact with sharp object, unspecified |
| W25.0 | Contact with broken glass | |
| Place of Occurrence (Y92) | Y92.239 | Hospital (unspecified) |
| Y92.009 | Private residence (unspecified) | |
| Y92.813 | Airplane | |
| Y92.832 | Beach | |
| Activity (Y93) | Y93.15 | SCUBA diving |
| Y93.19 | Water activity NEC | |
| Y93.89 | Activity specified NEC | |
| Status (Y99) | Y99.0 | Civilian activity done for income or pay |
| Y99.8 | Leisure activity | |
| Y99.1 | Military activity |
Usage Note:
Assign external cause codes per icd10cm_eindex_2025.pdf guidelines if the medical record documents an external cause (e.g., barotrauma from flying/diving, trauma from object) leading to the perforation requiring repair. For routine chronic otitis media, external cause codes are not applicable.*
Includes
- Tympanic Membrane Repair - Grafting to close perforation
- Canalplasty - Repair/reconstruction of ear canal if performed
- Atticotomy - Opening of the attic region if performed
- Middle Ear Surgery - Exploration and cleaning of middle ear space
- Graft Material - Harvesting and placement of graft (e.g., temporalis fascia, tragal cartilage)
- Initial or Revision - Applies to first-time or repeat procedures
- Anesthesia - Local or General (typically General)
- Immediate Post-op Care - Recovery room monitoring
Excludes
| Code | Description | Reason |
|---|---|---|
| 69633 | Tympanoplasty with mastoidectomy | Mastoid bone removed |
| 69635 | Tympanoplasty with ossicular chain reconstruction | Ossicles reconstructed (unless bundled by payer) |
| 69636 | Tympanoplasty with ossicular chain reconstruction with mastoidectomy | More extensive |
| 69637 | Tympanoplasty with stapes fixation | Stapes involved |
| 69638 | Tympanoplasty with stapes fixation with mastoidectomy | More extensive |
| 69641 | Tympanoplasty with mastoidectomy, complete or radical | Different extent |
| 69644 | Stapes mobilization | Different procedure |
| 69650 | Revision stapes operation | Different procedure |
| 69662 | Ossicular chain reconstruction (prosthetic) | If reported separately (check bundling) |
| 69666 | Ossicular chain reconstruction (autograft) | If reported separately (check bundling) |
| 69667 | Ossicular chain reconstruction (allograft) | If reported separately (check bundling) |
Note
CPT 69631 description states “including… middle ear surgery”. Some payers bundle ossicular reconstruction (69635) into 69631 if minimal manipulation occurs. Verify payer policy.
Assistant Surgeon Information
| Payer Type | Assistant Payable | Typical Reimbursement |
|---|---|---|
| Medicare | Yes (Status Indicator 1) | 16% of surgeon fee |
| Commercial | Varies by contract | 10-20% of surgeon fee |
| Medicaid | Varies by state | 10-16% of surgeon fee |
Modifiers for Assistant Surgeon:
- 80 - Assistant surgeon
- 81 - Minimum assistant surgeon
- 82 - Assistant surgeon (when qualified resident not available)
- AS - Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
Work RVU Breakdown (2025 Medicare Physician Fee Schedule)
| Component | RVU Value | Description |
|---|---|---|
| Work RVU | 10.66 | Physician work effort |
| Practice Expense RVU | 5.45 | Facility/equipment costs |
| Malpractice RVU | 1.85 | Liability insurance costs |
| Total RVU (Non-Facility) | 17.96 | Office-based setting (Rare) |
| Total RVU (Facility) | 17.96 | Hospital/ASC setting (Common) |
Note
RVU values may vary by geographic location due to GPCI adjustments. Tympanoplasty is predominantly performed in ASC or Hospital Outpatient settings.
MS-DRG Information (Inpatient Procedures)
Important: Tympanoplasty is overwhelmingly performed as outpatient or ambulatory surgery center (ASC) procedures. Inpatient admission is rare and usually requires significant comorbidities or complications.
If performed in an inpatient setting, 69631 may map to the following MS-DRGs:
| MS-DRG | Description | Relative Weight (Approx.) |
|---|---|---|
| 068 | Other Ear, Nose, Mouth, Throat Procedures | 1.15 |
| 067 | Other Ear, Nose, Mouth, Throat Diagnoses | 0.95 |
| 064 | Head & Neck Malignancy with Major OR Procedure | 2.85 (If malignancy present) |
CC/MCC Considerations:
- MCC: Severe malnutrition, respiratory failure, tracheostomy
- CC: Asthma, pneumonia, dehydration, anemia, uncontrolled diabetes
Global Period
| Period | Days | Services Included |
|---|---|---|
| Pre-operative | 1 day | Day before surgery |
| Intra-operative | 0 days | Day of surgery |
| Post-operative | 90 days | 90 days following surgery |
| Total Global | 90 days | All related E/M services included |
Services NOT included in global period:
- Treatment for unrelated conditions
- Return to OR for complications (use modifier 78)
- Decision for surgery (use modifier 57 if within global of another procedure)
- Staged procedures (use modifier 58)
Modifiers
| Modifier | Description | When to Use |
|---|---|---|
| 50 | Bilateral procedure | When performed on both ears |
| 51 | Multiple procedures | When additional distinct procedures performed |
| 52 | Reduced services | Procedure partially reduced |
| 53 | Discontinued procedure | Procedure stopped due to patient condition |
| 57 | Decision for surgery | E/M on day of surgery leading to decision |
| 58 | Staged procedure | Planned return to OR during global period |
| 59 | Distinct procedural service | Separate from other same-day procedures |
| 76 | Repeat procedure by same physician | Same procedure repeated |
| 77 | Repeat procedure by different physician | Same procedure by different surgeon |
| 78 | Return to OR for complication | Unplanned return during global period (e.g., graft failure) |
| 79 | Unrelated procedure during global | Different procedure during global period |
| 80 | Assistant surgeon | Assistant surgeon present |
| LT | Left side | Left ear (if not using 50) |
| RT | Right side | Right ear (if not using 50) |
| 22 | Increased procedural services | Significant additional work (e.g., severe scarring) |
Coding Examples
Example 1: Chronic Tympanic Membrane Perforation
CPT: 69631-RT
ICD-10-CM: H72.01 (Central perforation of tympanic membrane, right ear)
ICD-10-CM: H90.11 (Conductive hearing loss, unilateral, right ear)
Description: Patient underwent right tympanoplasty without mastoidectomy
for chronic perforation. Temporalis fascia graft used. Ossicles intact.
Canalplasty performed.
Example 2: Bilateral Tympanoplasty
CPT: 69631-50
ICD-10-CM: H72.03 (Central perforation of tympanic membrane, bilateral)
Description: Patient underwent bilateral tympanoplasty without mastoidectomy.
Grafts placed on both sides.
Example 3: Traumatic Perforation (Using External Cause Codes)
CPT: 69631-LT
ICD-10-CM: H72.92 (Unspecified perforation of tympanic membrane, left ear)
External Cause: W26.9 (Contact with sharp object), Y92.009 (Home), Y99.8 (Leisure)
Description: Patient sustained traumatic perforation from cotton swab injury
at home. Tympanoplasty performed to repair defect. External cause codes
assigned per icd10cm_eindex_2025.pdf guidelines.
Example 4: Barotrauma Perforation (Using External Cause Codes)
CPT: 69631-RT
ICD-10-CM: H72.91 (Unspecified perforation of tympanic membrane, right ear)
External Cause: W94.31 (Change in air pressure, during descent in aircraft), Y92.813 (Airplane)
Description: Patient sustained perforation due to barotrauma during flight
descent. Tympanoplasty performed. External cause codes assigned per
icd10cm_eindex_2025.pdf guidelines.
Example 5: Revision Tympanoplasty
CPT: 69631-58-RT
ICD-10-CM: H72.01 (Central perforation of tympanic membrane, right ear)
Description: Patient returned to OR within global period of initial procedure
for graft failure. Revision tympanoplasty performed. Modifier 58 appended.
Documentation Requirements
Operative Report Must Include:
- Preoperative Diagnosis
- Postoperative Diagnosis
- Procedure Performed (Tympanoplasty without mastoidectomy)
- Laterality (Left, Right, or Bilateral)
- Approach (Endaural, Postauricular, Transcanal)
- Graft Material (Temporalis fascia, tragal cartilage, perichondrium, etc.)
- Ossicular Chain Status - CRITICAL (Intact vs. Reconstructed)
- Mastoid Status - CRITICAL (Must document mastoid was NOT removed)
- Canalplasty/Atticotomy - If performed (included in code)
- Complications (Facial nerve injury, bleeding, etc.)
- Packing/Device - Type of packing placed
Key Phrases to Document:
- “Tympanoplasty performed without mastoidectomy”
- “Ossicular chain intact” (or document reconstruction separately if allowed)
- “Graft placed under/over remnant”
- “Canalplasty performed as needed”
- “No mastoid bone removed”
- “Hemostasis achieved”
- “Packing placed in ear canal”
Medical Necessity
Indications for 69631:
- Chronic Tympanic Membrane Perforation - Persistent hole in eardrum
- Conductive Hearing Loss - Due to perforation or ossicular fixation
- Chronic Otitis Media - Recurrent infections due to perforation
- Water Intolerance - Inability to get ear wet due to perforation
- Cholesteatoma (Limited) - If removed without mastoidectomy (rare)
- Traumatic Perforation - Non-healing traumatic injury
Contraindications:
- Active Infection - Usually delayed until infection controlled
- Only Hearing Ear - Relative contraindication (risk benefit analysis)
- Eustachian Tube Dysfunction - Severe dysfunction may lead to graft failure
- Medically Unstable - Cannot tolerate anesthesia
Common Denial Reasons
| Denial Code | Reason | Resolution |
|---|---|---|
| CO-50 | Medical necessity | Provide audiogram showing conductive loss |
| CO-97 | Bundled service | Verify ossicular reconstruction not bundled |
| CO-16 | Missing information | Submit operative report specifying no mastoidectomy |
| CO-22 | Billing/coding error | Verify 69631 vs 69633 (mastoidectomy status) |
| CO-109 | Not covered by payer | Check patient benefits for ENT procedures |
Compliance Considerations
- Mastoidectomy Status - The most critical audit point. If mastoid bone is removed, 69633 is correct. If not, 69631.
- Ossicular Chain - If ossicles are reconstructed, 69635 may be required instead of 69631. Verify payer bundling rules.
- Bilateral Billing - Verify payer preference for Modifier 50 vs. LT/RT with units of 2.
- Global Period - 90-day global applies. Do not bill routine post-op visits.
- External Causes - Assign per icd10cm_eindex_2025.pdf if trauma/barotrauma is documented.
- Revision vs. Complication - Use modifier 58 for planned staged revision, 78 for unplanned return for complication.
Related Procedures
| CPT | Description | Relationship |
|---|---|---|
| 69633 | Tympanoplasty with mastoidectomy | More extensive |
| 69635 | Tympanoplasty with ossicular chain reconstruction | Ossicles reconstructed |
| 69636 | Tympanoplasty with ossicular chain reconstruction with mastoidectomy | More extensive |
| 69637 | Tympanoplasty with stapes fixation | Stapes involved |
| 69641 | Tympanoplasty with mastoidectomy, complete or radical | Different extent |
| 69436 | Tympanostomy with tubes | Often performed concurrently |
| 69662 | Ossicular chain reconstruction (prosthetic) | Component of 69635 |
Clinical Pearls
- Graft Success - Success rates typically 85-95% for primary tympanoplasty.
- Ossicular Status - Preoperative audiogram should suggest ossicular status; intraoperative findings dictate code selection (69631 vs 69635).
- Water Precautions - Patients must keep ear dry post-op until healed.
- Hearing Improvement - Goal is to close air-bone gap; may not restore normal hearing.
- External Causes - For divers or pilots with barotrauma, document activity for correct ICD-10 coding (W94.23/W94.31).
- Pediatric Considerations - Often performed with adenoidectomy if Eustachian tube dysfunction present.
Quick Reference Card
┌─────────────────────────────────────────────────────────┐
│ CPT 69631 - Tympanoplasty Without Mastoidectomy │
├─────────────────────────────────────────────────────────┤
│ Global Period: 90 days │
│ Assistant Allowed: Yes (Status 1) │
│ Bilateral: Yes (Modifier 50 or LT/RT) │
│ wRVU: 10.66 │
│ Key Documentation: No Mastoidectomy, Ossicle Status │
│ Common ICD-10: H72.0-, H66.3-, H90.0- │
│ MS-DRG: 068 (Rarely Inpatient) │
│ Ext. Cause: W94.23/W94.31 (Barotrauma), W26.9 (Trauma) │
└─────────────────────────────────────────────────────────┘
Last Updated: February 2026 Code Status: Active Next Review: January 2027