Clinical Indicators
Stapedectomy
| Procedure |
CPT |
FUD |
| Stapedectomy or Stapedotomy with reestablishment of ossicular
chain continuity, with or without use of foreign material |
69660 |
90 |
| Revision of stapedectomy or Stapedotomy |
69662 |
90 |
Indications
1. History... (in addition to hearing loss, list all appropriate)
| a) |
Hearing loss - age of onset, duration, progression, and
disability. Also see tests. |
| b) |
Otosclerosis in opposite ear - not suspected, suspected or
confirmed. |
| c) |
Family history of otosclerosis - none, suspected,
confirmed. |
| d) |
Tinnitus - present or absent. Describe severity and
frequency. |
| e) |
Vertigo - present or absent. Severity and frequency. |
| f) |
Prior stapedectomy - outcome for hearing, post-op vertigo? |
2. Physical Examination... all required
| a) |
Absence of acute or chronic infection. |
| b) |
Description of both ear canals and tympanic membranes (the
tympanic membrane should be intact on the side scheduled for surgery). |
3. Tests... all required
| a) |
Audiometry
- Pure Tone Average - air 25 dB or greater
- Pure Tone - bone - 10-15 dB air bone gap of 0.5 - 2kH . May add 10 dB at
2.0 kH to allow for effect of Carhart notch. In case of profound loss and bone
testing not valid, provide rationale for suspecting otosclerosis.
- Speech and discrimination of both ears.
|
| b) |
Tuning fork - 512 cps Weber and Rinne lateralization to ear for
proposed surgery and reversal of Rinne (Bone > Air) strongly support
diagnosis and decision to operate at lower Air/Bone gap. |
| c)* |
Tympanogram and Acoustic Reflex - normal pressure and absent
reflex support diagnosis.
*Guideline Reviewers generally placed more confidence in 512 tuning fork
than tympanometry. |
Postoperative Observations
| 1. |
Vertigo--notify surgeon if unresponsive to medication. Severe
symptoms could justify decision to keep patient overnight. |
| 2. |
Bleeding--reinforce dressing. |
| 3. |
Facial weakness on side of surgery. |
| 4. |
Emesis |
Outcome Review
1. One Week
| a) |
Healing--Are there signs of infection such as discharge, pain
or swelling? |
| b) |
Inner ear--Are there signs of inner ear reaction such as
vertigo? |
| c) |
Untoward reaction to any medications |
2. Beyond One Month
| a) |
Hearing--document with audiogram. |
| b) |
Tinnitus--none, same, better, worse. |
| c) |
Vertigo--none, same, better, worse. |
Associated ICD-9 Diagnostic Codes
| 385.03 |
Tympanosclerosis involving tympanic membrane, ear ossicles,
and middle ear |
| 385.09 |
Tympanosclerosis involving other combination of
structures |
| 385.10 |
Adhesive middle ear disease, unspecified as to
involvement |
| 385.12 |
Adhesions of drum head to stapes |
| 385.19 |
Other middle ear adhesion and combinations |
| 385.22 |
Impaired mobility of other ear ossicles |
| 385.23 |
Discontinuity or dislocation of ear ossicles |
| 385.24 |
Partial loss or necrosis of ear ossicles |
| 387.0 |
Otosclerosis involving oval window, nonobliterative |
| 387.8 |
Other otosclerosis |
| 387.9 |
Otosclerosis, unspecified |
| 389.00 |
Conductive hearing loss, unspecified |
| 389.1 |
Sensorineural hearing loss, unspecified |
| 389.18 |
Sensorineural hearing loss of combined types |
Additional Information
Assistant Surgeon -- N
Supply Charges -- Not Allowed
Prior Approval -- N
Anesthesia Code(s)
00120 00124 00126
Patient Information
Stapedectomy/Stapedotomy is a middle ear operation to restore hearing
related to a frozen bone or bones in the middle ear. This allows improvement of
hearing by restoring vibration of the middle ear bones to the fluid of the
middle ear.
Complications from stapedectomy are infrequent and are usually related to
uncommon variations in anatomy or birth defects. The likelihood of total
hearing loss is rare. Facial paralysis is extremely rare for stapedectomy. Loss
of taste on the side of the tongue is a common complaint that usually resolves
within a few months. Some dizziness after surgery is normal and may last
several days or weeks. Severe or disabling dizziness is less common and could
be a symptom of inner ear disturbances. Tinnitus that was present before
surgery commonly persists, but could disappear or diminish. On the other hand,
tinnitus may develop as a result of surgery.
Failure to improve hearing occurs in about 2% of cases. If there is
deterioration of hearing after successful surgery and adequate nerve function
remains, it may be possible to restore that hearing by additional surgery. The
likelihood of success in those cases has been estimated at 60-80%. A hearing
aid may be a reasonable alternative to surgery and that option should be
discussed. Unless otherwise advised by your surgeon, stapedectomy for
otosclerosis is an elective procedure.
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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