Otolaryngology Coding Alert

"We'll tell you which lymph-removal codes to report with 60252 Following a thyroidectomy, otolaryngologists may perform a limited, modified or radical neck dissection, so you should know how to report these procedures accurately to recoup pay for your physician's thyroidectomy and dissection services.
 
To help you master the coding variations for these procedures, we've provided the following scenarios in which the otolaryngologist performs a total thyroidectomy but the lymph-removal procedures differ. Use 60252 for Thyroidectomy With Limited Neck Dissection If you code an operative report that describes a total thyroidectomy and a limited neck dissection, you should report 60252 (Thyroidectomy, total or subtotal for malignancy; with limited neck dissection) for both operations.
 
Scenario 1: Your otolaryngologist removes both thyroid lobes with the isthmus and pyramid lobe tissue. He also identifies and excises all enlarged lymph nodes.
 
If the malignancy has not spread significantly, the otolaryngologist may excise only a few selected lymph nodes. In this case, he performs a thyroidectomy with limited neck dissection.
 
Coding for this combination operation is easy. CPT contains a single code that incorporates both the thyroidectomy and the limited neck dissection - 60252 - says Tara Normand, CPC, coder at Baton Rouge ENT Associates in Louisiana. Assign One Code for Thyroidectomy, Radical Neck Dissection  When your otolaryngologist performs a radical neck dissection in addition to a thyroidectomy, 60254 (... with radical neck dissection) includes both procedures. You shouldn't unbundle the procedures.
 
Scenario 2: During a total thyroidectomy, an otolaryngologist must sacrifice the spinal accessory nerve, jugular vein and sternocleidomastoid muscles to remove a malignant lymphatic chain.
 
In this case, report only 60254 (... with radical neck dissection) for the thyroidectomy with radical neck dissection. By definition, you shouldn't separately report the radical neck dissection (38720, Cervical lymphadenectomy [complete]), Normand says. 

Separately Code the Most Common Procedure  When the surgeon performs a thyroidectomy and modified radical neck dissection, you should separately report the neck dissection.
 
Scenario 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.
 
Most thyroidectomies with neck dissections involve modified radical neck dissections. But CPT doesn't include a code for this combination procedure.
 
The National Correct Coding Initiative (NCCI) doesn't bundle neck dissections with thyroidectomies. Therefore, you should code each procedure using multiple-procedure rules, says Andrew Borden, CCS-P, CPC, CMA, reimbursement manager in the department of otolaryngology and communication sciences at Medical College of Wisconsin in Milwaukee.
 
Use 60240 (Thyroidectomy, total or complete) for the thyroidectomy. You may use this code even if the patient doesn't have a malignancy" " Borden says.
 
But most total thyroidectomy-neck dissection cases involve malignant neoplasm he says. For the modified radical neck dissection you should report 38724 (Cervical lymphadenectomy [modified radical [...]