Summary & Overview
CPT 69635: Tympanic Membrane Reconstruction with Mastoidectomy
Headline: CPT code 69635 defines combined tympanic membrane reconstruction with mastoidectomy — a key otologic procedure for chronic ear disease. Lead: CPT code 69635 covers initial or revision tympanoplasty performed with removal of all or part of the mastoid to address chronic infection and tympanic membrane perforation; ossicular chain reconstruction is explicitly excluded.
CPT code 69635 represents a significant surgical service in otolaryngology addressing chronic middle ear disease and persistent eardrum perforations. Nationally, this procedure matters because it can restore hearing, control chronic infection, and reduce recurrent healthcare utilization. Common sites of service include hospital operating rooms and ambulatory surgery centers where otologic surgical care is delivered.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of clinical context, common service settings, and the elements that define the procedure. The publication outlines typical billing considerations, common modifiers used in practice (listed separately), and related coding where available. It also highlights benchmarks and policy updates relevant to payers and providers, and clarifies what is included in the CPT descriptor versus services that would require additional codes. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 69635 describes an initial or revision surgical procedure that reconstructs the tympanic membrane (eardrum) to repair a perforation and includes removal of all or part of the mastoid to treat chronic infection. The procedure may involve reconstruction of the ear canal, an incision into the tympanic attic, tympanic membrane repair, and other surgeries of the middle ear. This descriptor specifies that reconstruction of the ossicular chain is not included.
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Service type: Otologic surgery combining tympanoplasty with mastoidectomy (initial or revision)
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Typical site of service: Hospital operating room or ambulatory surgery center
Clinical & Coding Specifications
Clinical Context
A 45-year-old patient presents with chronic otorrhea, recurrent middle ear infections, and a persistent tympanic membrane perforation with conductive hearing loss despite conservative management. Examination and CT imaging demonstrate chronic tympanic membrane perforation with granulation tissue and coalescent disease in the mastoid air cells. The otologic surgeon schedules a combined tympanoplasty with cortical mastoidectomy under general anesthesia. Intraoperative steps include a postauricular incision, removal of mastoid diseased air cells (mastoidectomy), incision into the tympanic attic as needed, and reconstruction of the tympanic membrane using autologous graft material such as temporalis fascia. The ossicular chain is inspected but not reconstructed during this initial or revision procedure. Typical workflow includes preoperative evaluation and testing (audiogram, CT temporal bones), perioperative anesthesia and antibiotic prophylaxis, the operative procedure in an ambulatory surgery center or hospital operating room, immediate postoperative monitoring in the PACU, and follow-up visits for wound checks, audiometric testing, and endoscopic otologic evaluation. Common payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Office or other outpatient service, initial | When this is the initial procedure performed during the operative encounter and not a global pre- or postoperative only service |