Sigmoid Sinus Resurfacing During Mastoidectomy

Question:

I have an ENT provider that performed a Mastoidectomy (69502) with sigmoid sinus resurfacing for pulsatile tinnitus. What CPT would I use for the sigmoid sinus resurfacing using bone cement and dust?

Answer:

A standard cortical mastoidectomy includes exposure and skeletonization of the sigmoid sinus. When additional work is performed to resurface or reconstruct a dehiscent sigmoid sinus for pulsatile tinnitus, this typically represents increased complexity of the mastoidectomy and is best reported with modifier 22 appended to CPT 69502 (or 69601 for revision cases). Because CPT does not provide a specific code for sigmoid sinus resurfacing and the work is performed through the mastoid, an unlisted code may need to be used in situations where the operative work is extensive and cannot be reasonably captured with modifier 22. Bone dust or bone pate obtained incidentally from mastoid drilling is considered local bone and is included when no separate donor incision is made. Bone cement is reported by the facility using the appropriate HCPCS supply code and is not separately reported by the physician.

*This response is based on the best information available as of 01/22/26.