Crystal's MCW Coder Hub🩺 CPT 69641 — Tympanoplasty with Mastoidectomy (without Ossicular Chain Reconstruction)
Short Definition
Surgical repair of the tympanic membrane (eardrum) combined with a mastoidectomy, including canalplasty and middle ear surgery, without reconstruction of the ossicular chain.
Long / Clinical Definition
CPT 69641 describes a combined otologic procedure in which the surgeon performs tympanoplasty (reconstruction and repair of the tympanic membrane and middle ear) along with a mastoidectomy (surgical removal of diseased mastoid air cells). The procedure may also encompass canalplasty (widening of the external auditory canal for better visualization and access) and any other required middle ear surgical manipulation.
Critically, this code is used when the ossicular chain — the three small bones of the middle ear (malleus, incus, and stapes) that conduct sound — is not reconstructed as part of the procedure. If any ossicular reconstruction is performed using the patient’s own bone or cartilage, you would step up to CPT 69642. If reconstruction uses a synthetic prosthesis (PORP or TORP), you would step to CPT 69643 or 69644, depending on canal wall status.
The type of mastoidectomy performed (simple/complete, modified radical, radical) is not specified by this code and does not change the code selection here. What matters is the presence of mastoidectomy + tympanoplasty WITHOUT ossicular chain reconstruction. This code can represent either an initial or a revision/secondary procedure.
Anatomy & Clinical Context
The mastoid bone is the posterior portion of the temporal bone, located just behind the pinna of the ear. Its honeycomb-like interior is filled with air cells that communicate with the middle ear through the mastoid antrum. Chronic middle ear infections (chronic otitis media) can spread into these air cells, causing mastoiditis — a serious infection requiring surgical debridement.
The tympanic membrane (TM) separates the outer ear canal from the middle ear. Perforations can result from chronic infection, trauma, or cholesteatoma. Cholesteatoma — an abnormal, destructive growth of squamous keratinizing epithelium — is one of the most common reasons a combined tympanoplasty with mastoidectomy is required, as it can erode bone and destroy middle ear structures.
Full CPT Descriptor
Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); without ossicular chain reconstruction
What Is Included (Bundled — Do NOT Bill Separately)
The following are considered integral components of CPT 69641 and are not separately reportable:
- Canalplasty (widening of the external auditory canal)
- Atticotomy (opening of the epitympanic recess/attic for disease access)
- Middle ear surgery/exploration
- Tympanic membrane repair/graft placement (when obtained via the same incision)
- Mastoidotomy or antrostomy (lesser procedures are bundled when a full mastoidectomy is performed)
- Exploratory tympanotomy
- Tympanostomy tube placement performed at the same time
- Harvest of temporalis fascia graft (when obtained through the same surgical incision)
Coding Tip: If the graft (e.g., temporalis fascia, tragal cartilage, perichondrium) is harvested through a separate, distinct incision from the primary surgical approach, the graft harvest may be separately reportable. Document clearly.
What Is NOT Included (May Be Separately Reportable)
- Ossicular chain reconstruction — moves the code to 69642, 69643, or 69644
- Contralateral ear procedure — these codes are unilateral; append Modifier 50 if performed bilaterally at the same operative session (clinically rare)
- Facial nerve decompression (69720, 69725) — separately reportable if performed
- Cochlear implant procedures
- Separate graft harvest through a distinct incision (may be separately reportable with appropriate graft harvest code)
- Labyrinthectomy — separately reportable if performed concurrently
Excludes / Important Distinctions
| Code | Description | Key Difference from 69641 |
|---|---|---|
| 69620 | Myringoplasty | Limited to drumhead/donor area only; middle ear NOT entered |
| 69631 | Tympanoplasty WITHOUT mastoidectomy; without OCR | No mastoidectomy performed |
| 69635 | Tympanoplasty with antrotomy/mastoidotomy; without OCR | Only antrostomy or mastoidotomy (lesser than full mastoidectomy) |
| 69642 | Tympanoplasty with mastoidectomy; WITH ossicular chain reconstruction | Ossicular chain IS reconstructed (with own bone/tissue) |
| 69643 | Tympanoplasty with mastoidectomy; intact/reconstructed canal wall; without OCR | Canal wall status specified + preserved or reconstructed |
| 69645 | Tympanoplasty with mastoidectomy; radical or complete; without OCR | Radical/complete mastoidectomy (canal wall down, creating mastoid bowl) |
Code Tree / Family
Tympanoplasty Code Family (69631-69646)
│
├── WITHOUT Mastoidectomy
│ ├── 69631 — Without OCR
│ ├── 69632 — With OCR (patient tissue)
│ └── 69633 — With OCR + synthetic prosthesis (PORP/TORP)
│
├── WITH Antrotomy/Mastoidotomy (lesser than full mastoidectomy)
│ ├── 69635 — Without OCR
│ ├── 69636 — With OCR
│ └── 69637 — With OCR + synthetic prosthesis
│
└── WITH Mastoidectomy (FULL — 69641-69646)
├── ► 69641 — Without OCR ◄ (THIS CODE)
├── 69642 — With OCR (patient tissue/bone)
├── 69643 — Intact/reconstructed canal wall; without OCR
├── 69644 — Intact/reconstructed canal wall; with OCR
├── 69645 — Radical/complete; without OCR
└── 69646 — Radical/complete; with OCR
RVU / Reimbursement Data (CY 2025)
| RVU Component | Value |
|---|---|
| Work RVU (wRVU) | 14.49 |
| Facility PE RVU | ~5.60 |
| Non-Facility PE RVU | ~5.60 |
| Malpractice RVU | ~0.51 |
| Total Facility RVU (approx.) | ~20.60 |
| CY 2025 Conversion Factor | $32.3465 |
| Approx. Medicare Facility Payment | ~$666.00 |
Note for the profee coder in you: wRVU of ~14.49 puts this in the moderate-high complexity surgical range for ENT. This is a 90-day global procedure, meaning all routine pre-op (day before) and post-op care for 90 days are bundled into this single surgical payment. Document any unrelated E&M services clearly during the global period and use Modifier 24 (unrelated E&M during global) or Modifier 79 (unrelated procedure during global) when appropriate.
Global Period & Surgical Package
| Component | Detail |
|---|---|
| Global Period | 090 (1-day pre-op + 90-day post-op) |
| Pre-op included | Yes (day before surgery) |
| Post-op included | Yes (90 days) |
| Intra-op complications | Included (not separately reportable) |
| Modifier 24 use | Unrelated E&M during global period |
| Modifier 25 use | Significant, separate E&M same day as procedure |
| Modifier 79 use | Unrelated procedure during global period |
| Modifier 58 use | Staged/planned procedure during global period |
Assistant Surgeon Payable
Yes — Assistant at Surgery IS payable for CPT 69641.
- This is a complex, 90-day global period procedure and meets the CMS threshold (assistant needed in ≥5% of cases nationally)
- Use Modifier 80 (Assistant Surgeon — full procedure participation)
- Use Modifier 81 if the assistant only participates in a portion of the procedure
- Use Modifier 82 if a qualified resident is unavailable and the assistant performs the entire operation
- Medicare pays the assistant surgeon at 16% of the primary surgeon’s fee schedule amount
- Note: In a teaching hospital with a training program and a qualified resident available, Medicare will NOT pay for an assistant at surgery — keep this in mind for your inpatient profee coding workflow
Bilateral Surgery
- Indicator: 1 — the 150% bilateral payment adjustment applies
- 69641 is a unilateral procedure by code descriptor
- Append Modifier 50 for bilateral performance at the same operative session
- Payment = lower of total actual charge for both sides OR 150% of the single-code fee schedule amount
- Bilateral performance of this procedure is clinically uncommon but does occur in patients with bilateral chronic otitis media or bilateral cholesteatoma
Multiple Procedure Reduction
- Indicator: 2 (Standard multiple procedure reduction applies)
- If 69641 is performed alongside other procedures, standard reductions apply: 100% / 50% / 50% / 50% / 50%
- The highest-valued procedure is paid at 100%; additional procedures are subject to 50% reduction
- Always list the highest RVU procedure first on the claim
MS-DRG Assignments (Inpatient — When Applicable)
As an inpatient profee coder, this is your bread and butter context. When 69641 is billed in the inpatient setting, the MS-DRG is driven by the ICD-10-PCS procedure code on the facility claim, not the CPT. However, knowing the associated DRGs helps confirm medical necessity and expected LOS.
| MS-DRG | Description | MDC |
|---|---|---|
| 129 | Major Head and Neck Procedures with MCC | MDC 03 |
| 130 | Major Head and Neck Procedures with CC | MDC 03 |
| 131 | Major Head and Neck Procedures without CC/MCC | MDC 03 |
Profee Tip: For the profee (professional fee) claim, you are billing the CPT code (69641) against the physician’s NPI regardless of the facility’s MS-DRG assignment. The ICD-10-CM diagnosis codes you assign on the profee claim should align with the documented indication for surgery. Always query if the operative note and H&P don’t clearly support the primary diagnosis used on the facility side.
ICD-10-CM Diagnosis Codes (Common Medical Necessity Drivers)
These are the most commonly paired diagnoses that support medical necessity for CPT 69641. Laterality matters — always specify right, left, or bilateral where applicable.
Cholesteatoma
| ICD-10-CM | Description |
|---|---|
| H71.01 | Cholesteatoma of attic, right ear |
| H71.02 | Cholesteatoma of attic, left ear |
| H71.11 | Cholesteatoma of tympanum, right ear |
| H71.12 | Cholesteatoma of tympanum, left ear |
| H71.21 | Cholesteatoma of mastoid, right ear |
| H71.22 | Cholesteatoma of mastoid, left ear |
| H71.31 | Diffuse cholesteatosis, right ear |
| H71.32 | Diffuse cholesteatosis, left ear |
Chronic Otitis Media / Suppurative
| ICD-10-CM | Description |
|---|---|
| H66.11 | Chronic tubotympanic suppurative otitis media, right |
| H66.12 | Chronic tubotympanic suppurative otitis media, left |
| H66.21 | Chronic atticoantral suppurative otitis media, right |
| H66.22 | Chronic atticoantral suppurative otitis media, left |
| H66.3X1 | Other chronic suppurative otitis media, right ear |
| H66.3X2 | Other chronic suppurative otitis media, left ear |
Mastoiditis
| ICD-10-CM | Description |
|---|---|
| H70.001 | Acute mastoiditis without complications, right ear |
| H70.002 | Acute mastoiditis without complications, left ear |
| H70.011 | Subperiosteal abscess of mastoid, right ear |
| H70.012 | Subperiosteal abscess of mastoid, left ear |
| H70.11 | Chronic mastoiditis, right ear |
| H70.12 | Chronic mastoiditis, left ear |
| H70.13 | Chronic mastoiditis, bilateral |
Tympanic Membrane Perforation
| ICD-10-CM | Description |
|---|---|
| H72.01 | Central perforation of tympanic membrane, right ear |
| H72.02 | Central perforation of tympanic membrane, left ear |
| H72.11 | Attic perforation of tympanic membrane, right ear |
| H72.21 | Other marginal perforations, right ear |
| H72.81 | Other perforations of tympanic membrane, right ear |
Conductive Hearing Loss (Secondary Diagnosis)
| ICD-10-CM | Description |
|---|---|
| H90.11 | Conductive hearing loss, unilateral, right ear |
| H90.12 | Conductive hearing loss, unilateral, left ear |
| H90.0 | Conductive hearing loss, bilateral |
HCC (Hierarchical Condition Category) Relevance
CPT 69641 itself is a procedure code and does not carry an HCC value.
The diagnosis codes paired with 69641 are predominantly in the ear/mastoid category (ICD-10 H60-H95) and do not map to CMS-HCC risk adjustment categories under the standard CMS-HCC model. Chronic otitis media, cholesteatoma, and mastoiditis are not HCC-mapped conditions. This means billing this procedure does not directly impact a patient’s RAF (Risk Adjustment Factor) score for Medicare Advantage purposes.
For your profee workflow: HCC capture is not a concern with this code family. However, if the patient has comorbid conditions documented in the pre-op H&P (e.g., diabetes, CHF, COPD), ensure those are captured on the claim even as secondary diagnoses when they are actively managed or affect the surgical care — those comorbidities may indeed map to HCCs and support RAF optimization.
Coding Examples
Example 1 — Straightforward Canal Wall Up Tympanomastoidectomy
A 42-year-old female with a 3-year history of chronic right ear drainage and documented cholesteatoma of the right attic presents for elective surgery. The ENT performs a postauricular approach, canal wall up mastoidectomy, middle ear exploration, excision of cholesteatoma, and tympanic membrane repair using temporalis fascia graft harvested through the same postauricular incision. No ossicular reconstruction was performed.
CPT: 69641 (RT modifier per payer requirement) ICD-10-CM: H71.01 (Cholesteatoma of attic, right ear), H66.11 (Chronic tubotympanic suppurative otitis media, right)
Example 2 — Bilateral NOT Separately Coded Without Modifier 50
Same patient as above, except disease was found bilaterally and the surgeon performed the procedure on both ears during the same operative session.
CPT: 69641-50 ICD-10-CM: H71.03 (Cholesteatoma of attic, bilateral), H66.13 (Chronic tubotympanic suppurative otitis media, bilateral)
Example 3 — Do NOT Use 69641 — Ossicular Chain Reconstruction Performed
Operative note documents tympanoplasty with mastoidectomy AND the surgeon repositioned and reshaped the patient’s incus to reconstruct the ossicular chain.
Correct CPT: 69642 (NOT 69641 — ossicular chain reconstruction was performed using the patient’s own bone)
Example 4 — Do NOT Use 69641 — Only Antrostomy Performed (Not Full Mastoidectomy)
Operative note documents tympanoplasty with mastoidotomy/antrostomy only; surgeon did not perform a full mastoidectomy. No ossicular reconstruction.
Correct CPT: 69635 (NOT 69641 — only mastoidotomy/antrostomy performed, not a full mastoidectomy)
Example 5 — Inpatient Profee Claim Scenario
Patient admitted for chronic mastoiditis with subperiosteal abscess, right. ENT performs urgent tympanoplasty with mastoidectomy the following morning.
CPT (Profee): 69641-RT ICD-10-CM (Profee): H70.011 (Subperiosteal abscess of mastoid, right ear), H90.11 (Conductive hearing loss, unilateral, right ear) Expected Inpatient MS-DRG (Facility): 130 or 131 depending on CC/MCC status Modifier Note: If you are coding the operative session and the surgeon also performed a separate, significant E&M on admission day, append Modifier 57 to the E&M if the decision for surgery was made at that encounter.
Key Modifiers Summary
| Modifier | When to Use |
|---|---|
| RT / LT | Right/Left ear — payer-specific requirement; always document laterality |
| 50 | Bilateral procedure performed at same operative session |
| 80 | Assistant surgeon (full procedure) |
| 81 | Assistant surgeon (partial procedure) |
| 82 | Assistant surgeon when resident unavailable |
| 22 | Increased procedural services (extensive/complex case — requires documentation) |
| 51 | Multiple procedures (applied to secondary procedure by payer, not typically appended manually) |
| 57 | Decision for surgery made at the pre-op E&M visit (same day or day before major procedure) |
| 58 | Staged or related procedure during the 90-day global period |
| 78 | Unplanned return to OR for complication during global period |
| 79 | Unrelated procedure during global period |
| 24 | Unrelated E&M visit during global period |
Related CPT Codes
TABLE code_number AS "CPT Code", title AS "Description"
FROM "CPT Codes"
WHERE contains(code_family, "69641")
SORT code_number ASCRelated Diagnosis Notes
TABLE title AS "Term", aliases AS "Aliases"
FROM "Med Terms"
WHERE contains(tags, "Ear") OR contains(tags, "Mastoid") OR contains(tags, "Otitis")
SORT title ASCQuick Reference Card
| Field | Value |
|---|---|
| CPT Code | 69641 |
| Full Descriptor | Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); without ossicular chain reconstruction |
| Surgical Specialty | Otolaryngology / ENT |
| Unilateral/Bilateral | Unilateral (Modifier 50 for bilateral) |
| Global Period | 090 (90-day post-op) |
| wRVU (CY2025) | ~14.49 |
| Assistant Payable | Yes |
| HCC Applicable | No |
| Ossicular Reconstruction | NOT included (use 69642+ if performed) |
| Mastoidectomy Type | Not specified by code |
| Initial or Revision | Both |
That’s your full note! A few heads-up for your Quartz/Obsidian setup:
- The
code_familylist in the YAML uses the array format (each entry on its own- "code"line) to avoid any colon issues in frontmatter. - All values that could be interpreted as numbers or special characters (like code numbers) are wrapped in quotes in the YAML.
- The Dataview queries at the bottom are templated for your vault structure — adjust the
FROMpaths to match your actual folder names. - The code tree section uses a fenced code block so it renders cleanly in Quartz without Obsidian trying to interpret the box-drawing characters as markdown.