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Otolaryngology Coding Alert

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Should You Break Out Dissection?

Question: 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. Can I report the modified neck dissection in addition to the thyroidectomy? Tennessee Subscriber Answer: Yes. CPT doesn't include a code for a thyroidectomy and modified radical neck dissection. So you should separately report the neck dissection. Use 60240 (Thyroidectomy, total or complete) for the thyroidectomy. And report the modified radical neck dissection with 38724 (Cervical lymphadenectomy [modified radical neck dissection]). To indicate that the surgeon performs multiple procedures in the same session, you should append modifier 51 (Multiple procedures) to the lesser-valued code. In this case, the modified radical neck dissection (38724) has more relative value units (34.87) than the thyroidectomy (60240) (23.53 RVUs). So you should report 38724 first, followed by 60240-51.

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