Recur cholesteatoma of postmastoidectomy cavity, left ear

This code signifies the regrowth of a cholesteatoma within the surgical cavity of the left ear, specifically after a mastoidectomy procedure. A cholesteatoma is an abnormal, noncancerous skin growth that can develop in the middle ear and mastoid bone, potentially causing bone erosion and hearing loss. Its recurrence in a post-surgical space indicates a persistent or re-emergent disease process.

Apply this code when documentation clearly indicates a recurrent cholesteatoma identified in the left ear's mastoidectomy cavity. This diagnosis typically follows a previous mastoidectomy and subsequent clinical or imaging findings confirming the regrowth of the cholesteatoma. Supporting documentation should include operative reports, pathology findings, and imaging studies (e.g., CT scans) that specify the location and recurrent nature of the cholesteatoma.

• Ensure documentation specifies "recurrent" and "postmastoidectomy cavity" to differentiate from primary or non-recurrent cholesteatomas.
• Verify the laterality (left ear) is explicitly stated in the medical record.
• Do not confuse with codes for primary cholesteatoma or cholesteatoma in an intact tympanic membrane.