This is the related article from coding institute. Do I code for a total or a partial? Thyroidectomies are performed for malignancies as well as for non-malignant reasons such as enlargement of the thyroid gland, or goiter. This type of thyroid cancer commonly metastasizes to the lymph nodes. And then 60225 is what contralateral subtotal lobectomy. A third pyramidal lobe sometimes extends from the isthmus. A fifth-digit subclassification is needed to identify presence or absence of thyrotoxic crisis or storm. Thyroid Nodules Thyroid nodules are abnormal growths or lumps in the thyroid gland.
If a nodule is with hyperthyroidism or thyrotoxicosis, assign code 242. Modifier -59 is attached to 60252 because 38724 is a higher-valued procedure 31. For example if cancer is detected in the remaining thyroid tissue or nearby lymph nodes the otolaryngologist may need to remove the remaining tissue. A code is invalid if it has not been coded to the full number of characters required for that code, including the 7 th character, if applicable. Nontoxic nodular goiter is classified to category 241. When malignancy is not involved, the surgeon may attempt to preserve thyroid function by saving portions of the gland.
A near-total thyroidectomy is classified to code 06. Instead, it is classified to code E89. For total thyroidectomy without neck dissection report 60240. Similarly a radical neck dissection does not accurately describe a modified radical which is a much more selective and complicated procedure. Some lymphoma starts in the thyroid, not just in the lymph nodes.
When a complete lobe is removed 60220 should be reported. Note: If a bilateral limited neck dissection is performed with a total thyroidectomy bill 60252 and 38700-59 suprahyoid lymphadenectomy; distinct procedural service. As in your example, if cancer is detected in the remaining thyroid tissue or nearby lymph nodes, the otolaryngologist may need to remove the remaining tissue. It may produce a fever, extreme weakness, mood swings, confusion, altered consciousness, coma, and enlarged liver with jaundice. Toxic goiters are classified to category 242 and were discussed under the hyperthyroidism section.
So that would be the answer for your question here, having the right thyroid lobectomy done. Now 6021 says with the contralateral, which means opposite side, subtotal lobectomy including the isthmus. Hypothyroidism, secondary to pituitary disease. Should I bill for another thyroid surgery with neck dissection? The thyroid is the largest of the endocrine glands, consisting of two lateral lobes connected by an isthmus. More specific codes: A more specific code should be selected. Malignancy of the thyroid gland is assigned to code 193.
When hypothyroidism is seen in pregnancy, it is often because an individual already has hypothyroidism and needs to increase their levothyroxine dose to account for the increased thyroxine binding globulin present in pregnancy. Similarly a subtotal thyroidectomy involves removal of the greater portion of the entire thyroid gland. All product and company names are the registered trademarks of their original owners. If the thyroid nodule occurs with hyperthyroidism or thyrotoxicosis, assign code 242. If a limited neck dissection is performed the procedures should be coded: 38724 60252-59. Thyroidectomies and other related excisions, such as parathyroidectomies, can pose difficult coding challenges. So this is a thyroidectomy, removal of all remaining thyroid tissue following previous removal of a portion.
I have seen two posts but I am not understanding the rationale of the answers given. It can spread quickly to the lymph nodes and trachea and sometimes to other organs or bones. What is the correct for thyroidectomy? Correct billing for these procedures when performed together depends on the carrier. Code 38724 is listed first. The diagnosis is H-rthle cell carcinoma with metastatic involvement. Note: A subtotal lobectomy involves the excision of most of the thyroid lobe about 90 percent.
The neoplasm code should be sequenced first unless the functional condition meets the criteria for principal diagnosis. The second set of codes describes partial excisions: 60210 -- partial thyroid lobectomy unilateral; with or without isthmusectomy 60212 --. The use of any trade name or trademark is for identification and reference purposes only and does not imply any association with the trademark holder of their product brand. Combination Flag - The combination flag indicates that more than one code in the target system is required to satisfy the full equivalent meaning of a code in the source system. Other carriers may want modifier -51 multiple procedures appended to the lesser-valued procedure in this case 60240 with 27. In either case appropriate use of modifier -59 tells the carrier that a limited or radical neck dissection was performed on one side and a modified radical dissection was done on the other. Subsequently however the remaining tissue may need to be removed.
But unlike other procedures -- such as laryngectomies which are described by codes that either include radical neck dissection 31365 or do not 31360 -- thyroidectomies also include another category limited neck dissection that may be performed during the same session. A near-total thyroidectomy may be the procedure of choice, which leaves a small rim of the thyroid tissue around the parathyroid gland to reduce the risk of parathyroid damage. If a subtotal lobectomy including isthmusectomy which involves the excision of the narrow connection between the two lobes of the thyroid gland is also performed report 60225. This service is reported by yet another code. Now that you have the visual of a butterfly in mind with the isthmus in the middle, the first two codes are a biopsy and then an excision of an adenoma or cyst.
A 3-character code is to be used only if it is not further subdivided. When a modified radical neck dissection is performed with a total thyroidectomy neither 60252 nor 60254 should be billed Eisenberg says. Select Billable Codes to view only billable codes under E89 or select the Tabular List to view all codes under E89 in hierarchical order. Similarly a subtotal thyroidectomy involves removal of the greater portion of the entire thyroid gland. When only a part of one thyroid lobe is excised i.