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Thyroid lobectomy with excision of substernal goiter

Elaine Posted Thu 03rd of November, 2011 12:01:13 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 18:13:43 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.

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