Tympanoplasty & Tympanostomy CPT Codes: Complete Medical Coding Guide (2026)

Introduction: Middle Ear Surgery Coding Overview

Accurate CPT coding for middle ear surgical procedures is one of the most nuanced areas in otolaryngology (ENT) medical coding. Whether you are coding for a tympanoplasty or a tympanostomy, selecting the correct CPT code requires a thorough understanding of the surgical approach, the extent of repair, and whether ossicular reconstruction or prosthesis implantation was performed.

This comprehensive guide breaks down every CPT code for tympanoplasty and tympanostomy procedures — the two most commonly performed middle ear surgeries — to help medical coders, billing specialists, and ENT practices achieve accurate, compliant claim submission and maximum appropriate reimbursement.

Anatomy Quick Review: Why It Matters for Coding

The human ear is divided into three sections:

• Outer ear — the visible portion that captures sound
• Middle ear — responsible for transmitting sound vibrations to the inner ear
• Inner ear — processes sound and sends signals to the brain

The middle ear is the primary focus for both tympanoplasty and tympanostomy coding. It contains:

• Tympanic membrane (eardrum) — the thin membrane separating the outer and middle ear
• Ossicles (small bones) — the three smallest bones in the human body:
  • Malleus (hammer)
  • Incus (anvil)
  • Stapes (stirrup)
• Eustachian tube — connects the middle ear to the nasopharynx, equalizing pressure and draining mucus

Understanding which of these structures are involved in the surgery is the critical first step in selecting the correct CPT code.

Part 1: Tympanoplasty CPT Codes — Complete Coding Guide

What Is a Tympanoplasty?

A tympanoplasty is a surgical procedure performed to repair a defect or perforation in the tympanic membrane (eardrum). Depending on the severity and location of the defect, the repair may also involve reconstruction of the ossicular chain or implantation of a prosthetic device.

Tympanoplasties are classified based on three key factors that directly determine the correct CPT code:

1. Whether a mastoidectomy is performed (and what type)
2. Whether ossicular chain reconstruction is required
3. Whether a synthetic prosthesis (PORP or TORP) is implanted

Tympanic Membrane Repair — CPT Code 69610

CPT 69610 — Tympanic membrane repair, with or without site preparation of perforation for closure, with or without patch

This is the most basic tympanoplasty code, used when only a simple repair of the tympanic membrane perforation is performed without any involvement of the ossicular chain or mastoid.

Procedure includes:

• Exposure and inspection of the defect
• Inspection of middle ear structures
• Removal of scar tissue from the middle ear
• Rimming of tissue around the perforation until bleeding occurs
• Harvesting of a tissue graft (skin, fat, tendon, or fascia) when needed
• Placement of absorbable sponge for graft support
• Positioning of the patch graft over the perforation

Key coding tip: If the hole is small enough, rimming alone may allow edges to heal without a graft. The code is reported the same way regardless of whether a patch graft is used.

Tympanoplasty Without Mastoidectomy — CPT Codes 69631–69633

This series of codes is used when the tympanic membrane requires repair without any mastoid involvement. The approach may be transcanal (through the ear canal) or post-auricular (behind the ear).

CPT Code 69631 — Tympanoplasty Without Ossicular Chain Reconstruction

CPT 69631 — Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction

When to use: The tympanic membrane is repaired but the ossicles are intact and do not require reconstruction.

Procedure may include:

• Canalplasty (drilling to widen a stenosed ear canal from repeated infections)
• Atticotomy (opening the tympanic attic by removing the scutum)
• Inspection and removal of scar tissue from the middle ear
• Tissue graft harvesting and placement

Key coding tip: If a canalplasty or atticotomy is performed as part of the tympanoplasty, it is included in CPT 69631 and should not be coded separately.

CPT Code 69632 — Tympanoplasty With Ossicular Chain Reconstruction

CPT 69632 — Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction (eg, postfenestration)

When to use: The ossicles (malleus, incus, and/or stapes) are damaged but repairable. The surgeon harvests tissue grafts and reconstructs the ossicular chain using the patient’s own tissue.

Key coding tip: The operative report must specifically document ossicular chain reconstruction with the patient’s own tissue. Look for documentation of the hammer, anvil, or stirrup bones being repaired or repositioned.

CPT Code 69633 — Tympanoplasty With Ossicular Chain Reconstruction and Prosthesis

CPT 69633 — Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis [PORP], total ossicular replacement prosthesis [TORP])

When to use: One or more ossicles are damaged beyond repair and require replacement with a synthetic prosthesis.

Two types of prostheses to know:

Key coding tip: The terms PORP or TORP in the operative report are strong indicators for CPT 69633. Always verify which prosthesis was implanted and document it in your coding notes.

Tympanoplasty With Antrotomy or Mastoidotomy — CPT Codes 69635–69637

This series applies when the surgeon performs a tympanoplasty plus drainage of the antrum (the cavity between the middle ear and temporal bone) or the mastoid bone — but without a full mastoidectomy.

• Antrotomy — drilling an osseous channel into the temporal bone to access the antrum
• Mastoidotomy — drilling into the mastoid bone for drainage purposes

Key coding tip: The key differentiator between this series (69635–69637) and the prior series (69631–69633) is the presence of a documented antrotomy or mastoidotomy. Always read the operative report carefully for mention of drilling into the antrum or mastoid bone for drainage.

Tympanoplasty With Mastoidectomy — CPT Codes 69641–69646

This is the most complex series of tympanoplasty codes, used when a full mastoidectomy is performed in addition to tympanic membrane repair.

What is a mastoidectomy? A mastoidectomy involves making a post-auricular incision (behind the ear) to expose and open the mastoid bone. The mastoid air cells are inspected, and infected or damaged tissue, purulent matter, and debris are removed.

Tympanoplasty With Mastoidectomy (Basic) — CPT Codes 69641–69642

Tympanoplasty With Mastoidectomy — Intact Canal Wall (CWU) — CPT Codes 69643–69646

A further distinction in mastoidectomy coding is whether the posterior bony ear canal wall is preserved or removed.

Canal Wall Up (CWU) / Intact Canal Wall (ICW):

• The posterior bony ear canal is preserved and reconstructed with cartilage or autologous bone grafts
• Accounts for approximately 70% of mastoidectomy procedures for chronic ear disease
• More commonly performed for cholesteatoma (abnormal skin cell collection inside the ear)

Key coding tip: The operative report should specifically mention canal wall up (CWU), intact canal wall (ICW), or canal wall down (CWD) technique. This determines which subgroup of codes (69643–69644 vs 69645–69646) applies.

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Tympanoplasty CPT Code Quick Reference Chart

Part 2: Tympanostomy CPT Codes — Complete Coding Guide

What Is a Tympanostomy?

A tympanostomy (also called myringotomy with tube insertion or ear tube surgery) is a procedure in which a small surgical opening is created in the tympanic membrane and a ventilating tube is placed to maintain that opening.

Why Is a Tympanostomy Performed?

The Eustachian tube connects the middle ear to the back of the nose (nasopharynx). Its functions include:

• Equalizing pressure in the middle ear in response to swallowing
• Draining mucus produced by the middle ear lining

When the Eustachian tube becomes chronically blocked (Eustachian tube dysfunction), it leads to:

• Negative pressure retracting the tympanic membrane
• Fluid accumulation in the middle ear space
• Hearing impairment
• Chronic otitis media (recurrent middle ear infection)

A tympanostomy relieves this by creating a pressure equalization opening in the eardrum and placing a tube to keep it open.

Tympanostomy Procedure Steps

1. A small incision is made in the tympanic membrane (myringotomy)
2. Fluid in the middle ear is removed by suction aspiration
3. The Eustachian tube is inflated with air to open it
4. A ventilating tube (PE tube/grommet) is inserted into the opening to maintain patency

Tympanostomy CPT Codes — 69433 and 69436

The two tympanostomy CPT codes are differentiated solely by the type of anesthesia used:

CPT Code 69433 — Tympanostomy With Local or Topical Anesthesia

CPT 69433 — Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia

When to use:

• Adult patients who can tolerate the procedure while awake
• Performed in an office or outpatient setting
• Local anesthetic drops or injection used

CPT Code 69436 — Tympanostomy Under General Anesthesia

CPT 69436 — Tympanostomy (requiring insertion of ventilating tube), general anesthesia

When to use:

• Pediatric patients (most common — children cannot cooperate with awake procedure)
• Adult patients who cannot tolerate local anesthesia
• Performed in an operating room or ambulatory surgery center

Key coding tip: The anesthesia type is the sole differentiating factor between 69433 and 69436. Always verify the anesthesia documentation in the operative report before selecting the code. General anesthesia is the norm for pediatric tympanostomy and will almost always be CPT 69436.

Tympanostomy CPT Code Comparison

Key Medical Coding Tips for Tympanoplasty and Tympanostomy

Top 5 Coding Mistakes to Avoid

1. Upcoding the tympanoplasty series Always verify the operative report confirms ossicular reconstruction or prosthesis implantation before coding 69632, 69633, or higher. Do not assume based on diagnosis alone.

2. Missing the mastoidectomy type Differentiating between simple mastoidectomy, antrotomy/mastoidotomy, and CWU vs CWD mastoidectomy is critical. One word in the operative note changes the entire CPT code.

3. Separately billing included components Canalplasty, atticotomy, and scar tissue removal are bundled into the tympanoplasty codes. Do not bill these separately.

4. Wrong anesthesia type for tympanostomy Confirm whether the operative report documents local, topical, or general anesthesia. Billing 69436 when local anesthesia was used — or vice versa — is a common and auditable error.

5. Not reading the full operative report Middle ear surgery documentation often uses multiple terms for the same structure. Know that malleus = hammer, incus = anvil, stapes = stirrup, and PORP/TORP indicate prosthesis use.

Conclusion

Accurate CPT coding for tympanoplasty and tympanostomy procedures requires meticulous review of the operative report and a clear understanding of middle ear anatomy. The key differentiating factors are:

• Tympanoplasty: mastoidectomy type + ossicular reconstruction + prosthesis type
• Tympanostomy: anesthesia type only

Mastering these distinctions ensures compliant claim submission, reduces audit risk, and supports appropriate reimbursement for ENT practices and surgery centers.