THE CODING EDGE® ARCHIVES

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Coding Recommendations - Feature Article 07/15/99
   

Procedure Practice
    

Using ICD-9-CM and CPT-4, assign codes for the procedure(s) described in this "real-life" patient report.

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Preoperative Diagnosis: Chronic benign suppurative otitis media with persistent anterior tympanic membrane perforation

Postoperative Diagnosis: Same

Procedure Performed: Right tympanoplasty with incudectomy and mastoidectomy

Description of Procedure: With the patient in the supine position, general ET anesthesia was administered and the right ear was prepped and draped in a sterile manner. A facial nerve monitor was hooked up. The postauricular skin was infiltrated with 5 cc of 1% Lidocaine with 1:100,000 epinephrine. A postauricular incision was made with a Bovie and temporalis fascia harvested and set aside to dehydrate. The skin was closed with interrupted 4-0 silk suture.

The operating microscope was swung into position and the ear examined transcanal. Four quadrant injections were carried out with 5 cc of 1% Lidocaine with 1:100,000 epi. At this point the usual vascular strip incisions were made. Margins of the drum perforation were freshened using a barber needle and cup forceps. A large amount of mucosal disease was noted to fill the entire middle ear. All diseased tissue was completely resected.

Examination of the ossicles revealed that the incus was frozen into position. The incudostapedial joint therefore was separated with the laser and the incus was removed. The tendon of the malleus was sectioned and the malleus moved freely as did the stapes. The stapes superstructure was noted to be intact. Mucosal disease was removed from around the oval window niche.

A simple mastoidectomy was performed with removal of all mucosal disease. This was accomplished with no problems. The fascial graft was then applied to tbe tympanic membrane in an underlay technique after Gelfoam had been placed over the cochlear promontory. Silastic blocks were left in the attic to support the Gelfoam. Ossicular reconstruction was postponed until a separate second stage procedure could be scheduled.

  

    

Using the above patient report(s), do your own coding and then compare it with our coding recommendations.

Notice: This part of our web site was prepared to assist in understanding and maintaining good coding skills. For proper use of this feature, reference must be made to official coding guidelines when necessary. The information here presented is only to be used as a supplement to those guidelines. Laguna Medical Systems, Inc., makes no representations or guarantees as to amounts that will be paid by Medicare or other third party payers.

 

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to reflect possible coding rules and regulation changes made after the publishing date.