Summary & Overview
CPT 69604: Revision Mastoidectomy with Tympanoplasty
CPT code 69604 covers revision mastoidectomy performed with tympanoplasty to repair a failed prior mastoidectomy and reconstruct the tympanic membrane. This code identifies a focused otologic surgical intervention used when persistent middle ear infection, eardrum perforation, and ongoing hearing loss follow an earlier surgery. Nationally, the code matters because it captures care for recurrent or chronic ear disease that may require repeat operative management and has implications for surgical outcomes, utilization monitoring, and payment policy for complex ear procedures.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise overview of clinical indications tied to the code, common sites of service, and the typical clinical context driving use of the code. Readers will find benchmarks for service classification, a summary of payer coverage considerations (where available), and guidance on how the procedure is categorized for billing and reporting purposes. The content also highlights procedural intent — achieving a dry ear and restoring tympanic membrane integrity — and situates the code within broader surgical management of recurrent otitis media and chronic suppurative middle ear disease.
Data not available in the input for specific payer policies, reimbursement rates, associated taxonomies, and ICD-10 diagnosis mappings.
Billing Code Overview
CPT code 69604 describes a revision of a previously performed mastoidectomy in conjunction with tympanoplasty, or reconstruction of the eardrum. The procedure is performed when an initial mastoidectomy and tympanoplasty failed to produce a dry ear, resulting in recurrent otitis media with purulent drainage, persistent eardrum perforation, and recurrent or residual hearing loss.
Service type: Revision mastoidectomy with tympanoplasty (ear reconstruction)
Typical site of service: Hospital outpatient surgical department or ambulatory surgical center, where otologic surgical procedures and middle ear reconstructions are routinely performed.
Clinical & Coding Specifications
Clinical Context
A 52-year-old patient presents with persistent otorrhea, recurrent otitis media, a chronic tympanic membrane perforation, and persistent conductive hearing loss several months after an initial mastoidectomy with tympanoplasty. Otoscopic exam shows a persistently moist mastoid bowl and residual cholesteatoma or granulation tissue. Audiometry confirms residual conductive hearing loss. The otologic surgeon schedules a revision mastoidectomy with tympanoplasty to eradicate infection, remove recurrent disease, and reconstruct the tympanic membrane to achieve a dry ear and improve hearing.
The clinical workflow includes preoperative assessment (history, otologic exam, audiometry, CT temporal bones), informed consent outlining risks of revision surgery, perioperative antibiotics as indicated, general anesthesia, surgical exploration of the mastoid cavity and middle ear, removal of recurrent disease, reconstruction of the tympanic membrane (type I–III tympanoplasty techniques as appropriate), possible ossicular chain reconstruction, hemostasis, and placement of tympanic packing. Postoperative care includes outpatient follow-up for wound and ear cavity inspection, audiometric reassessment, and management of any residual infection or complications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the surgeon's professional service separate from technical component provided by facility. |