Example 1: Your otolaryngologist removes both thyroid lobes with the isthmus and pyramid lobe tissue. He also identifies and excises all enlarged lymph nodes. The malignancy has not spread significantly, so the otolaryngologist excises only a few selected lymph nodes. He then performs a thyroidectomy with limited neck dissection.
Solution 1: You should report only 60252 (Thyroidectomy, total or subtotal for malignancy; with limited neck dissection). This code includes reimbursement for the thyroidectomy and the limited dissection.
Example 2: During a total thyroidectomy, an otolaryngologist dissects all the levels of lymph nodes and must sacrifice the spinal accessory nerve, jugular vein and sternocleidomastoid muscles to remove a malignant lymphatic chain.
Solution 2: In this case, report only the thyroidectomy with radical neck dissection with 60254 (Thyroidectomy, total or subtotal for malignancy; with radical neck dissection). By definition, you shouldn't separately report the radical neck dissection (38720, Cervical lymphadenectomy [complete]). Look to 38724 for Modified Radical CPT, however, throws you a curve ball when your physician combines thyroidectomy with modified radical neck dissection. None of the thyroidectomy codes specify this combination, which you-ll have to code out separately.
Example 3: An otolaryngologist removes both thyroid lobes. But when removing a malignant lymphatic chain, she manages to preserve the spinal accessory nerve, jugular vein, and sternocleidomastoid muscles.
Solution 3: Because CPT doesn't include a code for the thyroidectomy with modified radical neck dissection, you should report 60240 (Thyroidectomy, total or complete) with 38724 (Cervical lymphadenectomy [modified radical neck dissection]). In a modified radical neck dissection, the surgeon dissects all levels of the lymph nodes on one side of the neck but spares the sternocleidomastoid muscle, the spinal accessory nerve, and the jugular vein. Watch Out for Other Terms Although op report titles clue you into how to code a procedure, otolaryngologists may use several monikers for a modified radical neck dissection.
Example 4: -Does anyone know the code for a functional neck dissection?- asks Michelle Johnson, charge entry/coder at Mercy-ENT Clinic in Rodgers, Ark.
Solution 4: -Functional neck dissection is the same as a modified radical neck dissection,- Cobuzzi says. Another name your surgeon might use is selective [...]