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Clinical Indicators: Mastoidectomy

Clinical Indicators: Mastoidectomy
Approach ProcedureCPTRBRVS Global Days
Simple mastoidectomy6950190
Complete mastoidectomy6950290
Modified radical mastoidectomy6950590
Radical mastoidectomy6951190
Petrous apicectomy (including radical mastoidectomy)6053090
Revision mastoidectomy, resulting in complete mastoidectomy6960190
Revision mastoidectomy, resulting in modified radical mastoidectomy6960290
Revision mastoidectomy, resulting in radical mastoidectomy6960390
Revision mastoidectomy, resulting in tympanoplasty6960490
Revision mastoidectomy, with apicectomy6960590
Tympanoplasty with antrotomy or mastoidotomy, without ossicular chain reconstruction6963590
Tympanoplasty with antrotomy or mastoidotomy, with ossicular chain reconstruction6963690
Tympanoplasty with antrotomy or mastoidotomy, with ossicular chain reconstruction and synthetic prosthesis6963790
Tympanoplasty with mastoidectomy, without ossicular chain reconstruction6964190
Tympanoplasty with mastoidectomy, with ossicular chain reconstruction 6964290
Tympanoplasty with mastoidectomy, with intact or reconstructed canal wall, without ossicular chain reconstruction6964390
Tympanoplasty with mastoidectomy, with intact or reconstructed canal wall, with ossicular chain reconstruction6964490
Tympanoplasty with mastoidectomy, radical or complete, without ossicular chain reconstruction6964590
Tympanoplasty with mastoidectomy, radical or complete, with ossicular chain reconstruction6964690
Mastoid obliteration 6967090
Approach ProcedureCPT RBRVS Global Days
Intraoperative Nerve Monitoring Procedure (Optional, at operating surgeon’s discretion)
CPT
Auditory evoked potentials for evoked response audiometry
and/or testing of the central nervous system; comprehensive
92585
Continuous intraoperative neurophysiology monitoring in the
operating room, one on one monitoring requiring personal
attendance, each 15 minutes (List separately in addition to code
for primary procedure)
95940
Continuous intraoperative neurophysiology monitoring, from
outside the operating room (remote or nearby) or for monitoring
of more than one case while in the operating room, per hour
(List separately in addition to code for primary procedure)
95941
Continuous intraoperative neurophysiology monitoring, from
outside the operating room (remote or nearby), per patient,
(attention directed exclusively to one patient) each 15 minutes
(list in addition to primary procedure)
G0453
Short-latency somatosensory evoked potential study, stimulation
of any/all peripheral nerves or skin sites, recording from the
central nervous system; in upper limbs
95925
*CPT 92540 and 92541 are “add-on” codes, formerly reported with CPT 95920, which has been deleted and replaced with these 2 new codes. In the 2013 final Medicare Physician Fee Schedule, however, The Centers for Medicare and Medicaid Services (CMS) elected not to accept the CPT Editorial Panel’s addition of CPT +95941, and instead, created a G code to report monitoring which occurs outside the operating room. Providers should therefore, report G0453. The American Medical Association’s Current Procedural Terminology (CPT®) does not limit CPT codes to any particular specialty. However, the CPT® introductory language and AMA coding guidance is clear that in order to bill these codes (+95940, +95941, or G0453) the service must be performed by a monitoring professional who is SOLELY DEDICATED to performing the intraoperative neurophysiologic monitoring and is available to intervene at all times during the service as necessary. The monitoring professional may not provide any other clinical activities during the same period of time. For more, access our CPT for ENT coding guidance article on the Academy’s website.
  1. History (one or more required)
    1. Postauricular periosteal swelling or pain unresponsive to medical treatment.
    2. Infected drainage from the ear unresponsive to medical treatment.
    3. Planned second look for intact wall mastoidectomy.
    4. Persistent middle ear disease unresponsive to management.
    5. Fullness in the ear, hearing loss or pain.
    6. Approach to failed tympanoplasty.
    7. Evidence of chronic disease in patient who may not be aware of a problem such as retraction
      pockets with squamous debris, cholesteatoma, mucous crusts from non-infected discharge, and glomus tympanicum.
    8. Benign/Malignant tumor of the mastoid/temporal bone.
    9. Advanced parotid malignancy.
    10. Risk of hearing loss.
  2. Physical Examination (required)
    1. Complete bilateral description of ear canal, tympanic membrane, postauricular area (if
      abnormal), facial nerve function and description of nystagmus (if present).
    2. Description of middle ear.
    3. Description of gross hearing.
  3. Tests
    1. Audiometry—pure tone and speech bilateral.
    2. Tympanometry
    3. Imaging
      • Temporal bone CT scan is optional.
        • Many ear conditions are diagnosed clinically (history and physical exam) and therefore a CT scan may not be necessary.
        • A CT scan may be necessary to document the presence or extent of disease (e.g. when the extent of the disease is unknown, when the disease is possibly much greater behind the ear canal, and/or other circumstances where an area is not seen during clinical examination)
        • A CT scan may be necessary to gain anatomical details prior to surgery. (e.g., cases of revision surgery to determine whether there is exposure of vital structures such as the sigmoid sinus, facial nerve, and dural integrity)
      • MRI is also optional (particularly DWI (diffusion weight imaging) MRI looking for cholesteatoma).
        • In cases of revision mastoid surgery for infection or cholesteatoma, it is often difficult to separate scar from disease (cholesteatoma) because they appear as opacification on CT scans. MRI scans are beneficial in these cases as scar and cholesteatoma look different on MRI.
        • MRI scans beneficial when identifying and diagnosing tumors preoperatively.

Postoperative Observations

  1. Bleeding
  2. Facial weakness
  3. Dizziness
  4. Mental status
  5. Pain
  6. Dressing
  7. Hearing loss

Outcome Review

  1. One Week
    1. Incision and cavity–Is there evidence of infection?
    2. Inner ear and facial nerve–Is there dizziness or facial weakness or sensorineural hearing loss (as determined by tuning fork test)?
  2. Beyond Two Months
    1. Hearing – document with audiogram.
    2. Tympanic membrane – Status of TM is tympanoplasty done.
    3. Mastoid cavity – Is it healed and dry?
    4. Infection – If this was the reason for the surgery, has it been controlled?
    5. Alteration in taste on ipsilateral side of tongue.

Associated ICD-10-CM Diagnostic Codes (Representative, but not all inclusive codes)

Nonsuppurative otitis media and eustachian tube disorder

  • H65.191 Other acute nonsuppurative otitis media, right ear
  • H65.192 Other acute nonsuppurative otitis media, left ear
  • H65.193 Other acute nonsuppurative otitis media, bilateral
  • H65.194 Other acute nonsuppurative otitis media, recurrent, right ear
  • H65.195 Other acute nonsuppurative otitis media, recurrent, left ear
  • H65.196 Other acute nonsuppurative otitis media, recurrent, bilateral
  • H65.01 Acute serous otitis media, right ear
  • H65.02 Acute serous otitis media, left ear
  • H65.03 Acute serous otitis media, bilateral
  • H65.04 Acute serous otitis media, recurrent, right ear
  • H65.05 Acute serous otitis media, recurrent, left ear
  • H65.06 Acute serous otitis media, recurrent, bilateral
  • H65.111 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), right ear.
  • H65.112 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), left ear.
  • H65.113 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), bilateral
  • H65.114 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, right ear
  • H65.115 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, left ear
  • H65.116 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent,bilateral
  • H65.117 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, unspecified ear
  • H65.111 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), right ear
  • H65.112 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), left ear
  • H65.113 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), bilateral
  • H65.114 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent,right ear
  • H65.115 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent,left ear
  • H65.116 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent,bilateral
  • H65.117 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, unspecified ear
  • H65.111 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), right ear
  • H65.112 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), left ear
  • H65.113 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), bilateral
  • H65.114 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, right ear
  • H65.115 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, left ear
  • H65.116 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, bilateral
  • H65.117 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, unspecified ear
  • H65.111 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), right ear
  • H65.112 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), left ear
  • H65.113 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), bilateral
  • H65.114 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, right ear
  • H65.115 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, left ear
  • H65.116 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent,bilateral
  • H65.117 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, unspecified ear
  • H65.111 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), right ear
  • H65.112 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), left ear
  • H65.113 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), bilateral
  • H65.114 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, right ear
  • H65.115 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent,left ear
  • H65.116 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent, bilateral
  • H65.117 Acute and subacute allergic otitis media (mucoid) (sanguinous) (serous), recurrent,unspecified ear
  • H65.21 Chronic serous otitis media, right ear
  • H65.22 Chronic serous otitis media, left ear
  • H65.23 Chronic serous otitis media, bilateral
  • H65.31 Chronic mucoid otitis media, right ear
  • H65.32 Chronic mucoid otitis media, left ear
  • H65.33 Chronic mucoid otitis media, bilateral
  • H65.31 Chronic mucoid otitis media, right ear
  • H65.32 Chronic mucoid otitis media, left ear
  • H65.33 Chronic mucoid otitis media, bilateral
  • H65.411 Chronic allergic otitis media, right ear
  • H65.412 Chronic allergic otitis media, left ear
  • H65.413 Chronic allergic otitis media, bilateral
  • H65.419 Chronic allergic otitis media, unspecified ear
  • H65.491 Other chronic nonsuppurative otitis media, right ear
  • H65.492 Other chronic nonsuppurative otitis media, left ear
  • H65.493 Other chronic nonsuppurative otitis media, bilateral
  • H65.91 Unspecified nonsuppurative otitis media, right ear
  • H65.92 Unspecified nonsuppurative otitis media, left ear
  • H65.93 Unspecified nonsuppurative otitis media, bilateral
  • H68.001 Unspecified Eustachian salpingitis, right ear
  • H68.002 Unspecified Eustachian salpingitis, left ear
  • H68.003 Unspecified Eustachian salpingitis, bilateral
  • H68.011 Acute Eustachian salpingitis, right ear
  • H68.012 Acute Eustachian salpingitis, left ear
  • H68.013 Acute Eustachian salpingitis, bilateral
  • H68.021 Chronic Eustachian salpingitis, right ear
  • H68.022 Chronic Eustachian salpingitis, left ear
  • H68.023 Chronic Eustachian salpingitis, bilateral
  • H68.101 Unspecified obstruction of Eustachian tube, right ear
  • H68.102 Unspecified obstruction of Eustachian tube, left ear
  • H68.103 Unspecified obstruction of Eustachian tube, bilateral
  • H68.111 Osseous obstruction of Eustachian tube, right ear
  • H68.112 Osseous obstruction of Eustachian tube, left ear
  • H68.113 Osseous obstruction of Eustachian tube, bilateral
  • H68.121 Intrinsic cartilagenous obstruction of Eustachian tube, right ear
  • H68.122 Intrinsic cartilagenous obstruction of Eustachian tube, left ear
  • H68.123 Intrinsic cartilagenous obstruction of Eustachian tube, bilateral
  • H68.131 Extrinsic cartilagenous obstruction of Eustachian tube, right ear
  • H68.132 Extrinsic cartilagenous obstruction of Eustachian tube, left ear
  • H68.133 Extrinsic cartilagenous obstruction of Eustachian tube, bilateral
  • H69.01 Patulous Eustachian tube, right ear
  • H69.02 Patulous Eustachian tube, left ear
  • H69.03 Patulous Eustachian tube, bilateral
  • H69.81 Other specified disorders of Eustachian tube, right ear
  • H69.82 Other specified disorders of Eustachian tube, left ear
  • H69.83 Other specified disorders of Eustachian tube, bilateral
  • H69.91 Unspecified Eustachian tube disorder, right ear
  • H69.92 Unspecified Eustachian tube disorder, left ear
  • H69.93 Unspecified Eustachian tube disorder, bilateral

Suppurative and unspecified otitis media

  • H66.001 Acute suppurative otitis media without spontaneous rupture of ear drum, right ear
  • H66.002 Acute suppurative otitis media without spontaneous rupture of ear drum, left ear
  • H66.003 Acute suppurative otitis media without spontaneous rupture of ear drum, bilateral
  • H66.004 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, right ear
  • H66.005 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, left ear
  • H66.006 Acute suppurative otitis media without spontaneous rupture of ear drum, recurrent, bilateral
  • H66.007 Acute suppurative otitis media without spontaneous rupture of ear drum,
    recurrent, unspecified ear
  • H66.011 Acute suppurative otitis media with spontaneous rupture of ear drum, right ear
  • H66.012 Acute suppurative otitis media with spontaneous rupture of ear drum, left ear
  • H66.013 Acute suppurative otitis media with spontaneous rupture of ear drum, bilateral
  • H66.014 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, right ear
  • H66.015 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, left ear
  • H66.016 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, bilateral
  • H66.017 Acute suppurative otitis media with spontaneous rupture of ear drum, recurrent, unspecified ear
  • H67.1 Otitis media in diseases classified elsewhere, right ear
  • H67.2 Otitis media in diseases classified elsewhere, left ear
  • H67.3 Otitis media in diseases classified elsewhere, bilateral
  • H66.10 Chronic tubotympanic suppurative otitis media, unspecified
  • H66.11 Chronic tubotympanic suppurative otitis media, right ear
  • H66.12 Chronic tubotympanic suppurative otitis media, left ear
  • H66.20 Chronic atticoantral suppurative otitis media, unspecified ear
  • H66.21 Chronic atticoantral suppurative otitis media, right ear
  • H66.22 Chronic atticoantral suppurative otitis media, left ear
  • H66.3X1 Other chronic suppurative otitis media, right ear
  • H66.3X2 Other chronic suppurative otitis media, left ear
  • H66.3X3 Other chronic suppurative otitis media, bilateral
  • H66.41 Suppurative otitis media, unspecified, right ear
  • H66.42 Suppurative otitis media, unspecified, left ear
  • H66.43 Suppurative otitis media, unspecified, bilateral

Mastoiditis and related conditions

  • H70.001 Acute mastoiditis without complications, right ear
  • H70.002 Acute mastoiditis without complications, left ear
  • H70.003 Acute mastoiditis without complications, bilateral
  • H70.011 Subperiosteal abscess of mastoid, right ear
  • H70.012 Subperiosteal abscess of mastoid, left ear
  • H70.013 Subperiosteal abscess of mastoid, bilateral
  • H70.091 Acute mastoiditis with other complications, right ear
  • H70.092 Acute mastoiditis with other complications, left ear
  • H70.093 Acute mastoiditis with other complications, bilateral
  • H70.11 Chronic mastoiditis, right ear
  • H70.12 Chronic mastoiditis, left ear
  • H70.13 Chronic mastoiditis, bilateral
  • H70.201 Unspecified petrositis, right ear
  • H70.202 Unspecified petrositis, left ear
  • H70.203 Unspecified petrositis, bilateral
  • H70.211 Acute petrositis, right ear
  • H70.212 Acute petrositis, left ear
  • H70.213 Acute petrositis, bilateral
  • H70.221 Chronic petrositis, right ear
  • H70.222 Chronic petrositis, left ear
  • H70.223 Chronic petrositis, bilateral
  • H95.191 Other disorders following mastoidectomy, right ear
  • H95.192 Other disorders following mastoidectomy, left ear
  • H95.193 Other disorders following mastoidectomy, bilateral ears
  • H95.111 Chronic inflammation of postmastoidectomy cavity, right ear
  • H95.112 Chronic inflammation of postmastoidectomy cavity, left ear
  • H95.113 Chronic inflammation of postmastoidectomy cavity, bilateral ears
  • H95.119 Chronic inflammation of postmastoidectomy cavity, unspecified ear
  • H95.131 Mucosal cyst of postmastoidectomy cavity, right ear
  • H95.132 Mucosal cyst of postmastoidectomy cavity, left ear
  • H95.133 Mucosal cyst of postmastoidectomy cavity, bilateral ears
  • H95.00 Recurrent cholesteatoma of postmastoidectomy cavity, unspecified ear
  • H95.01 Recurrent cholesteatoma of postmastoidectomy cavity, right ear
  • H95.02 Recurrent cholesteatoma of postmastoidectomy cavity, left ear
  • H95.121 Granulation of postmastoidectomy cavity, right ear
  • H95.122 Granulation of postmastoidectomy cavity, left ear
  • H95.123 Granulation of postmastoidectomy cavity, bilateral ears
  • H70.811 Postauricular fistula, right ear
  • H70.812 Postauricular fistula, left ear
  • H70.813 Postauricular fistula, bilateral

Other disorders of middle ear and mastoid

  • H71.91 Unspecified cholesteatoma, right ear
  • H71.92 Unspecified cholesteatoma, left ear
  • H71.93 Unspecified cholesteatoma, bilateral
  • H71.01 Cholesteatoma of attic, right ear
  • H71.02 Cholesteatoma of attic, left ear
  • H71.03 Cholesteatoma of attic, bilateral
  • H71.11 Cholesteatoma of tympanum, right ear
  • H71.12 Cholesteatoma of tympanum, left ear
  • H71.13 Cholesteatoma of tympanum, bilateral
  • H74.41 Polyp of right middle ear
  • H74.42 Polyp of left middle ear
  • H74.43 Polyp of middle ear, bilateral
  • H71.21 Cholesteatoma of mastoid, right ear
  • H71.22 Cholesteatoma of mastoid, left ear
  • H71.23 Cholesteatoma of mastoid, bilateral
  • H71.31 Diffuse cholesteatosis, right ear
  • H71.32 Diffuse cholesteatosis, left ear
  • H71.33 Diffuse cholesteatosis, bilateral
  • H74.8X9 Other specified disorders of middle ear and mastoid, unspecified ear

Additional Information

Assistant Surgeon — Y Supply Charges — N Prior Approval — N

Anesthesia Code(s)—00210; 00124; 00126

Patient Information

Mastoidectomy is an operation to remove disease from the bone behind the ear, when medical
management is inadequate. Sometimes a mastoidectomy is required in order to gain better exposure to
the disease. Mastoidectomy is effective in XX% of cases. Although complications do not often occur,
they include persistent ear drainage, infection in the mastoid cavity, and hearing loss. Weakness of the
face on the side of the surgery is a rare but potential hazard in mastoid surgery. There may be dizziness
for a short time after surgery, but it is rarely permanent. Loss of taste on the side of the tongue may
occur and last a few weeks, but may be permanent.

Important Disclaimer Notice

Clinical indicators for otolaryngology serve as a checklist for practitioners and a quality care review tool
for clinical departments. The American Academy of Otolaryngology—Head and Neck Surgery, Inc. and
Foundation (AAO-HNS/F) Clinical Indicators are intended as suggestions, not rules, and should be
modified by users when deemed medically necessary. In no sense do they represent a standard of care.

The applicability of an indicator for a procedure must be determined by the responsible physician in
light of all the circumstances presented by the individual patient.

Adherence to these clinical indicators will not ensure successful treatment in every situation.

The AAO-HNS/F 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. The AAO-HNS/F is not responsible for treatment
decisions or care provided by individual physicians.

CPT five-digit codes, nomenclature and other data are copyright 20014 American Medical Association.
All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT.
The AMA assumes no liability for the data contained herein.


© 2014 American Academy of Otolaryngology-Head and Neck Surgery. 1650 Diagonal Road, Alexandria, VA 22314.

Approved May 2014

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