What is the CPT code for excision of temporalis fascia?
To give an example, that temporalis fascia graft for a tympanoplasty when harvested through a separate incision would be coded with CPT 15769 for “direct excision.”
What is the CPT code for fascial graft?
The March 2007 CPT Assistant indicated that code 69631 includes the work of harvesting the graft material. Therefore, code 69631 should be reported regardless of whether the graft was harvested through the same incision or a separate incision. Therefore, it would not be appropriate to report a separate code for the fascial graft.
Do I need to report 20926 for temporalis fascia graft?
Rather, if a temporalis fascia graft is harvested through a separate skin incision then you may separately report 20926 (tissue graft). However, if the tympanoplasty is performed via post-auricular incision then 20926 is not separately reported for the temporalis fascia graft since it is considered a “local” graft.
What do you typically bill for tympanoplasty/temporalis fascia graft?
We routinely bill 69631 (tympanoplasty) and 20922 (temporalis fascia graft). We’ve been paid but now we’re being asked to give money back.
What is the CPT code for Tympanoplasty with temporalis fascia graft?
We routinely bill 69631 (tympanoplasty) and 20922 (temporalis fascia graft).
What is the CPT code for fascia graft?
CPT® Code 20920 in section: Fascia lata graft.
What is a temporalis fascia graft?
Temporalis fascia, placed as an underlay graft, is commonly used to repair tympanic membrane perforations. Graft failure, however, is a well recognized complication.
Why is temporalis fascia used as graft?
Autologous temporalis fascia is the most commonly used grafting material because of it convenient location and resistant to infection. Many other materials like skin, homologous tympanic membrane, dura, tragal cartilage, perichondrium and vein had been used with varying results.
What is procedure code 15771?
CPT Code 15771: Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; 50cc or less injectate: The RUC recommends the following physician time components: 50 minutes of pre-service time (30 minutes evaluation time, 10 minutes positioning time, 10 minutes scrub/dress/ ...
How do you harvest temporalis fascia graft?
The temporalis fascia can be harvested using an endaural, retroauricular approach or by an additional superior laterally based skin incision. After hav- ing inserted the self-retaining retractors during the endaural approach, it is preferable to harvest the temporalis fascia to avoid readjustment of the retrac- tors.
Where is the temporalis fascia?
The temporoparietal fascia (TPF) lies under the skin and subcutaneous tissue over the temporal fossa. It is also known as the superficial temporal fascia. It is continuous with the superficial musculoaponeurotic system that is inferior to the zygomatic arch.
Where is the temporalis muscle?
temporal fossaThe temporalis muscle attaches above to the bone and fascia in the temporal fossa, superior to the zygomatic arch, and below to the coronoid process of the mandible and along the mandibular ramus (Figure 6-17). The temporalis muscles primarily close the jaw while the middle fibers bilaterally retrude the mandible.
What is the difference between myringoplasty and tympanoplasty?
In myringoplasty, after gently cleaning the ear, the surgeon will insert the paper "patch" or gel foam through the ear canal. In tympanoplasty, the surgeon will take a small piece of tissue from under the skin behind or above your child's ear.
Why temporalis fascia is used as graft in tympanoplasty?
Abstract. Objectives: Temporalis fascia has become the most widely used graft for tympanoplasty, as it is strong, durable, and easy to procure and handle. However, the type of temporalis fascia graft to use (i.e. dry or wet) remains controversial.
What are the types of tympanoplasty?
Type I tympanoplasty is synonymous with myringoplasty. Type II: repair of the TM and middle ear; the malleus is eroded. Tympanoplasty involves grafting the TM to the incus. Type V: repair involves the stapes footplate, which is fixed.
What is Tympanomeatal flap?
tympanomeatal flaps have been useful in underlay tympanoplasty and other Otologic surgery. The elevated tympanomeatal flap allows access for a number of middle ear procedures like repair of TM or perilymph fistula, ossiculoplasty, Page 2 remove growths such as cholesteatoma and glomus tumour.
What is CPT 20926 used for?
Prior to 1/1/2020, CPT 20926 was used for transfer of tissue from one part of the body to another when we did not have a more specific code for that graft in CPT. This left coders and physicians using CPT 20926 to represent many different types of services – anything from liposuction to obtain some fat that was injected into the breast as part of a reconstruction to surgically excising a layer of temporal fascia which was inserted to repair the ear drum in a tympanoplasty procedure. The AMA reviewed CPT 20926 and its various uses last year and realized that this code was representing many different procedures all involving various anatomic sites and different amounts of clinical work to harvest the graft. As a result, they determined that the different types of grafts being reported with CPT 20926 should be better defined.
What is CPT code 15769?
As you can see, CPT 15769 is coded for “any autologous graft” (such as fat, fascia, etc.) where the graft is taken from the donor site by direct incision. The term autologous means “from the patient’s own body” so this type of graft is taken from one site in a patient’s body and implanted in another.
What is the code for autologous fat?
In contrast, if autologous fat is harvested by liposuction technique (where a needle is inserted and fat cells withdrawn and prepared for injection in another site in the body), you need to look at codes 15771-15774. To pick the right code (s), you first need to identify the recipient site (where the graft is going).
Is CPT 20926 still in the manual?
As of 1/1/20, CPT 20926 has been deleted. While you might be tempted to look for it’s replacement in the same section of CPT, the AMA has actually added 5 new codes to the Integumentary Section of the CPT manual (. The codes are distinguished by the method of obtaining the graft (direct excision vs. liposuction), the anatomic site where the graft is placed, and t he amount of fat injected when applicable for the type of graft. Here is an overview of the new codes:
What is the first code for tympanoplasty?
The first in this family of codes is 69631 Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction. As the descriptor language reflects, neither a mastoidectomy nor ossicular (malleus, incus, and stapes) reconstruction is performed.
What is the second family of tympanoplasty codes?
Unlike codes 69631-69633, the second family of tympanoplasty codes include mastoidotomy. Code 69635 Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); without ossicular chain reconstruction, does not include ossicular reconstruction, but does include elements of tympanoplasty as well as performance of mastoidectomy.
What is the code for mastoidectomy?
Differing from 69643, code 69644 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed canal wall, with ossicular chain reconstruction, includes, ossicular chain reconstruction. The ossicular chain reconstruction (OCR) may be with the patients own bone or with a prosthesis; the type of reconstructive material is not specified as it is with several of the other tympanoplasty codes.
What is the code for tympanic membrane repair?
Code 69643 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed wall, without ossicular chain reconstruction includes elements of tympanoplasty without ossicular reconstruction plus mastoidectomy that preserves the common wall between mastoid and ear canal or includes immediate reconstruction if the wall is taken down for removal of disease.
What is the code for a partial ossicular replacement?
Replacement of one or more of the ossicles using either a partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP), including mastoidotomy, with other elements of tympanoplasty is described by code 69637 Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis (PORP), total ossicular replacement prosthesis (TORP).
What is tympanoplasty surgery?
Tympanoplasty is a microsurgery that repairs, or removes disease involving, the tympanic membrane and/or the middle ear. This type of surgery is performed either transcanal through the ear canal (external auditory canal) or postauricular behind the ear. The tympanoplasty family of codes (69631-69646) describes tympanic membrane ...
What are the descriptors for tympanoplasty?
Therefore, you will observe that the tympanoplasty code descriptors have a distinct structure: The descriptors reference canalplasty, atticotomy, and/or middle ear surgery as inclusive procedures, when performed ( See Definitions) Mastoidectomy may or may not be performed .
Question 69643 vs 69645
Can someone explain the difference between 69643 and 69645? What makes 69645 radical/complete? The description I read of both codes sound identical so what is the main difference to distinguish which one to use? Here is the op report: Attention was then turned to behind the ear were a 15 blade...
Tympanoplasty with temporalis fascia graft
The doctor harvested a supra auricular temporalis fascia graft and set aside. Later in the procedure he placed the graft trans-canal (tympanoplasty). I came up with 69631 and 15769. Is it correct to bill the harvesting of the graft with this procedure?
Question Ossicular chain reconstruction
I wanted to get an opinion on this op report. I know there is no code for ossicular chain reconstruction or excision of canal cholesteatoma and the closest code would be 69632. The doctor did not repair the tympanic membrane but because of the reconstruction and removal of cholesteatoma, can I...
Question Myringoplasty and tympanoplasty
I have an op report and the procedure that was done is an "excision of right tympanic membrane and middle ear cholesteatoma with right gelfoam myringoplasty and then left gelfoam myringoplasty/repair of tympanic membrane perforation." From what I've researched, it looks like the code for the...
Grafts and tympanoplasty
I am confused on the graft codes during tympanoplasty. I know the graft is included in the code but what if the surgeon takes 2 grafts? He used a temporalis fascia graft and a tragal cartilage graft. Are both included in the tympanoplasty code or can I code for one of them? Would appreciate...
