Elaine Posted Thu 20th of October, 2011 19:05:13 PM
How would you code a thyroid lobectomy with excision of substernal goiter?
SuperCoder Answered Fri 21st of October, 2011 02:53:02 AM
In case of coding coding thyroidectomy procedures, detail docmentation is always crucial. The list of procedures vary as listed below:
60210, partial thyroid lobectomy, unilateral; with or without isthmusectomy.
60212, partial thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomy.
60220, total thyroid lobectomy, unilateral; with or without isthmusectomy.
60225, total thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomy.
60240, thyroidectomy, total or complete.
60252, thyroidectomy, total or subtotal for malignancy; with limited neck dissection.
60254, thyroidectomy, total or subtotal for malignancy; with radical neck dissection.
60260, thyroidectomy, removal of all remaining thyroid tissue following previous removal of a portion of thyroid.
60270, thyroidectomy, including substernal thyroid; sternal split or transthoracic approach.
60271, thyroidectomy, including substernal thyroid; cervical approach.
Plz check the documentation of report and pick the appropriate codes from the above. In case of a confusion, submit the report here.
Elaine Posted Mon 31st of October, 2011 20:02:23 PM
The report reads: "The skin incisions were made and carried down through the platysma muscle. Short subplatysmal flaps were elevated and these were held into position with ______ retractors. The strap muscles were divided in the midline. Having exposed the thyroid gland, there was a separate large substernal mass in the left paratracheal region. This was skeletonized and a biopsy was obtained which showed normal thyroid tissue. Using careful blunt and sharp dissection, the substernal portion of the mass was removed without difficulty. The left side right lobe also had some cystic changes and enlargement. The recurrent laryngeal nerve was identified in the paratracheal area and followed into the entrance into the larynx. There was significant fibrous changes and some small paratracheal lymph nodes present in the inferior border of the left thyroid lobe and a definite parathyroid gland was not identified here. The superior pole of the thyroid was ligated between hemostats. The thyroid gland was then mobilized off the trachea and cross clamped. The left thyroid lobe was removed. The cut edge of the thyroid was oversewn with 3-0 Vicryl suture. The wound was irrigated with copious amounts of sterile saline and checked again for hemostasis.
I'm looking at code 60270, and I believe this would include the 60220???
SuperCoder Answered Thu 03rd of November, 2011 18:11:33 PM
The major difference between the two codes is that CPT 60270 involves thyroidectomy including substernal thyroid, which is not included in 60220.
So, you are right in picking 60270 only.
Yes, it includes when the approach is same. Allows modifier when the approach is different, as 60220 may involve transcervical approach whereas 60270 involves transthoracic approach.