" The August issue of Otolaryngology Coding Alert
had an article about coding thyroid procedures that discussed the various procedures and how they differed. It also offered tips on coding thyroidectomies and neck dissections together, as well as removal of additional thyroid tissue after an earlier thyroidectomy.
Since then, readers have requested information on coding and billing several situations involving substernal thyroidectomies using a cervical approach:
Scenario No. 1: A transcervical approach is used to remove the substernal thyroid, coded 60271 (thyroidectomy, including substernal thyroid gland; cervical approach). Most of the time, only a unilateral hemithyroidectomy (also referred to as a total lobectomy) is performed because one lobe extends into the chest, causing symptoms. Sometimes, both lobes of the thyroid gland extend into the substernal space, so total thyroidectomy is required, again on both sides extending into the upper chest with a transcervical approach.
When coding this scenario, remember that 60271 is used to report a total thyroidectomy, says Lee Eisenberg, MD, an otolaryngologist in private practice in Englewood, N.J., and a member of CPT's editorial panel and executive committee. This is not as straightforward as it should be, because the code descriptor does not state either total"" or ""partial"" thyroidectomy.
Still" given that:
(a) elsewhere in the thyroid section CPT uses "thyroidectomy" to describe total thyroidectomies (partial thyroidectomies are referred to as lobectomies or isthmusectomies);
(b) all the codes surrounding 60271 describe total thyroidectomies; and
(c) Coders' Desk Reference states "The physician removes the thyroid including the substernal thyroid gland " it is reasonable to assume that 60271 describes a total thyroidectomy.
As a result in this situation 60271 should not be billed as:
A bilateral procedure using either modifier -50 (bilateral procedure) or -LT (left side) and -RT (right side).
An unusual service (modifier -22) that requires additional payment.
Note: If only one lobe is removed for a substernal thyroid the carrier may require that modifier -52 (reduced services) be appended to 60271.
Scenario No. 2: A total thyroidectomy is performed. One lobe is substernal the other is not substernal.
The difficulty here is related to the first scenario in that it also stems from incorrectly assuming that 60271 describes a partial thyroidectomy. If that were true 60220 (total thyroid lobectomy unilateral; with or without isthmusectomy) could be separately reported for the non-substernal lobe that is removed. Because 60271 describes a total thyroidectomy however no other code for the nonsubsternal lobectomy should be reported. In this situation 60271 may be reported even though only one of the two lobectomies performed was substernal.
Scenario No. 3: The patient is taken to the OR where a total thyroid lobectomy is performed. A week later pathology returns showing a carcinoma and removal of [...]