Clinical Indicators
Myringotomy and Tympanostomy Tubes
| Procedure |
CPT |
FUD |
| Myringotomy, local anesthesia |
69420 |
10 |
| Myringotomy, general anesthesia |
69421 |
10 |
| Tympanostomy tube insertion |
|
|
69433 |
10 |
|
|
69436 |
10 |
Indications
1. History... one required
| a) |
Severe acute otitis media (myringotomy). |
| b) |
Hearing loss > 30 dB in patient with otitis media with
effusion (myringotomy or tube). |
| c) |
Poor response (describe) to antibiotic for otitis media
(myringotomy or tube). |
| d) |
Impending mastoiditis or intra-cranial complication due to
otitis media (myringotomy). |
| e) |
Otitis media with effusion > 3 months (myringotomy or
tympanostomy tube). |
| f) |
Recurrent episodes of acute otitis media (more than 3 episodes
in 6 months or more than 4 episodes in 12 months) (tympanostomy tube). |
| g) |
Chronic retraction of tympanic membrane or pars flaccida
(tympanostomy tube). |
| h) |
Barotitis media control. |
| i) |
Autophony due to patulous eustachian tube. |
| j) |
Craniofacial anomalies that predispose to middle ear
dysfunction (e.g., cleft palate). |
| k) |
Middle ear dysfunction due to head and neck radiation and skull
base surgery. |
2. Physical Examination... required
| a) |
Description of tympanic membrane. |
| b) |
Description of middle ear space. |
3. Tests
| a) |
Audiometry--pure tones and/or Speech Reception Thresholds. |
| b) |
Tympanometry. |
Postoperative Observations
1. Persistent or profuse bleeding from ear?
2. Otorrhea?
Outcome Review
1. First Month
| a) |
Infection--Has there been any discharge from the ear requiring
treatment? |
| b) |
Tube-- Check placement and patency of tube. |
2.Beyond One Month
| a) |
Hearing--Is hearing improved? (Document with audiogram or
history and physical exam.) |
| b) |
Infection--Has there been a decrease in the number of ear
infections? |
| c) |
Tube--Is tympanostomy tube functioning? |
| d) |
Continued follow-up at last 6 months. |
Associated ICD-9 Diagnostic Codes
| 381.02 |
Acute mucoid otitis media |
| 381.10 |
Chronic serous otitis media, simple or unspecified |
| 381.20 |
Chronic mucoid otitis media, simple or unspecified |
| 381.30 |
Other and unspecified chronic nonsuppurative otitis media, not
specified as acute or chronic |
| 381.7 |
Patulous eustachian tube |
| 381.81 |
Dysfunction of eustachian tube |
| 382.00 |
Acute suppurative otitis media without spontaneous rupture of
tympanic membrane |
| 383.00 |
Acute mastoiditis without complications |
| 383.01 |
Subperiosteal abscess of mastoid |
| 383.02 |
Acute mastoiditis with other complications |
| 385.11 |
Adhesion of drum head to incus |
| 385.12 |
Adhesion of drum head to stapes |
| 385.13 |
Adhesion of drum head to promontory |
| 749.00 |
Cleft palate, unspecified |
| 749.01 |
Cleft palate |
| 749.02 |
Cleft palate, unilateral, incomplete |
| 749.03 |
Cleft palate, bilateral, complete |
| 749.04 |
Cleft palate, bilateral, incomplete |
| 749.20 |
Cleft palate with cleft lip, unspecified |
| 749.21 |
Cleft palate with cleft lip, unilateral, complete |
| 749.22 |
Cleft palate with cleft lip, unilateral, incomplete |
| 749.23 |
Cleft palate with cleft lip, bilateral, complete |
| 749.24 |
Cleft palate with cleft lip, bilateral, incomplete |
| 749.25 |
Cleft palate with cleft lip, other combinations |
| 754.0 |
Certain congenital musculoskeletal deformities of skull, face
and jaw |
| 758 |
Chromosomal anomalies |
Additional Information
Assistant Surgeon -- N
Supply Charges -- not allowed
Prior Approval -- N
Anesthesia Code(s)
00126
Patient Information
Myringotomy with or without tympanostomy tube insertion is the most commonly
performed ear operation. It is extremely safe and effective. Complications are
minor and usually in the form of infection, which may be treated with
antibiotics. The tube usually remains in place for 6 to 12 months, although it
may be rejected sooner or remain in place for years. Post-op care including
water precautions are individualized and will be discussed by your physician.
Occasionally the tympanic membrane fails to heal after tubes have been removed,
and the resulting perforation may require surgical repair. In some cases,
tympanostomy tubes may need to be replaced. Hearing improvement is usually
immediate after fluid has been removed from the ear. Failure to improve hearing
may indicate a second problem in the middle or inner ear.
Important Notice
The Clinical Indicators for Otolaryngology--Head and Neck Surgery
are guidelines only. In no sense do they represent a standard of care. The
applicability of an indicator for a procedure, and/or of the process or outcome
criteria, must be determined by the responsible physician in light of all the
circumstances presented by the individual patient. Adherence to these
guidelines will not ensure successful treatment in every situation. The
American Academy of Otolaryngology-Head and Neck Surgery, Inc. emphasizes that
these clinical indicators should not be deemed inclusive of all proper
treatment decisions or methods of care, nor exclusive of other treatment
decisions or methods of care reasonably directed to obtaining the same results.
© 2000 American Academy of Otolaryngology-Head and Neck Surgery.
One Prince Street, Alexandria, VA 22314.
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