Summary & Overview
CPT 69636: Tympanic Membrane Repair with Ossicular Reconstruction and Mastoidectomy
CPT code 69636 designates a comprehensive otologic surgical procedure combining tympanic membrane repair (tympanoplasty), ossicular chain reconstruction (ossiculoplasty), and mastoidectomy. This code captures cases in which a surgeon addresses both conductive hearing deficits and chronic or acute disease of the middle ear and mastoid in a single operative setting. Nationally, 69636 is important because it reflects complex, often multidisciplinary ear surgery with implications for surgical resource use, facility planning, and specialty reimbursement.
Key payers included in coverage discussions are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical and billing overview, typical sites of service, and what to expect in claims processing and coding capture for combined tympanoplasty/ossiculoplasty with mastoidectomy. The publication also outlines benchmarks and policy-relevant considerations for payers and providers, clinical context for when the combined procedure is billed, and notes on common documentation elements needed to support medical necessity.
Data not provided in the input include specific associated taxonomies, ICD-10 diagnosis pairings, payer-specific coverage rules, and related CPT codes.
Billing Code Overview
CPT code 69636 describes a combined otologic procedure in which the provider reconstructs the tympanic membrane (eardrum) to repair a perforation, reconstructs the ossicular chain to improve conductive hearing, and performs a mastoidectomy with removal of all or part of the mastoid air cells. The procedure may include reconstruction of the ear canal, incision into the tympanic attic, tympanic membrane repair, and other middle ear surgeries as part of the initial or revision operation.
-
Service type: Combined middle ear and mastoid surgical reconstruction involving tympanoplasty, ossiculoplasty, and mastoidectomy
-
Typical site of service: Hospital operating room or ambulatory surgical center specializing in otologic surgery
Clinical & Coding Specifications
Clinical Context
A 45-year-old patient presents with chronic otorrhea, conductive hearing loss, and a persistent tympanic membrane perforation after recurrent otitis media. Audiometry demonstrates an air-bone gap consistent with ossicular discontinuity and conductive hearing loss. After medical management and imaging (CT temporal bones) to evaluate mastoid disease and ossicular status, the patient is scheduled for a combined tympanoplasty, ossiculoplasty, and mastoidectomy to repair the tympanic membrane, reconstruct the ossicular chain, and remove diseased mastoid air cells.
The clinical workflow includes preoperative assessment (history, physical exam, audiometry, CT imaging), informed consent specifying possible procedures (type I–IV tympanoplasty, ossicular reconstruction with prosthesis or autograft, cortical or radical mastoidectomy as indicated), intraoperative tympanic membrane reconstruction and ossicular chain reconstruction with microscopic technique, mastoidectomy with removal of cholesteatoma or diseased air cells if present, and postoperative audiometric follow-up and wound checks. Typical site of service is an operating room in an ambulatory surgery center or hospital inpatient setting depending on disease extent and comorbidities. Service type: surgical otology procedure (reconstructive middle ear surgery with mastoidectomy).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier; standard reporting | Use when no additional modifier applies and global surgical package is billed. |