Four Tips To Optimize Thyroidectomy Billing
Published on Wed Aug 01, 2001
" Thyroidectomies and other related excisions pose unique coding problems for otolaryngologists. Thyroidectomies are performed for malignancies as well as for non-malignant reasons (such as enlargement of the thyroid gland, or goiter). In the latter case, the surgeon may try to save enough of the gland to preserve thyroid function.
CPT includes several thyroid excision codes, ranging from simple aspiration and biopsy to total thyroidectomy. These include partial lobectomies, total lobectomies (which may be inappropriately dictated as partial thyroidectomy" " adding to the confusion) and "subtotal" thyroidectomies and lobectomies where most of the lobe or complete thyroid has been removed.
When neck dissections are performed coding is further complicated. CPT includes codes -- like other neck-based excisions due to malignancy -- that should be reported when a thyroidectomy and a neck dissection are performed during the same session. 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.
Limited and modified radical neck dissections are sometimes confused even though a limited dissection is a much simpler procedure involving only a few selected lymph nodes. Similarly a radical neck dissection does not accurately describe a modified radical which is a much more selective and complicated procedure.
Finally if part of the thyroid was removed for reasons unrelated to malignancy with some thyroid tissue saved to preserve function the surgeon may subsequently remove the remaining tissue. This service is reported by a distinct CPT code.
Because there is such a variety of thyroidectomy and related codes terminology -- the code descriptions in CPT as well as the otolaryngologist's documentation -- is crucial when selecting the correct code (see story on page 60).
Tip 1: Understand How Thyroidectomy Codes Differ
The first three codes in the excision section describe minor thyroid procedures -- aspiration and/or injection biopsy and excision:
60001 -- aspiration and/or injection thyroid cyst
60100 -- biopsy thyroid percutaneous core needle
60200 -- excision of cyst or adenoma of thyroid or transection of isthmus.
The second set of codes describes partial excisions:
60210 -- partial thyroid lobectomy unilateral; with or without isthmusectomy
60212 -- ... with contralateral subtotal lobectomy including isthmusectomy
60220 -- total thyroid lobectomy unilateral; with or without isthmusectomy
60225 -- ... with contralateral subtotal lobectomy including isthmusectomy.
These procedures are easy to confuse notes Lee Eisenberg MD an otolaryngologist in private practice in Englewood N.J. and a member of CPT's editorial panel and executive committee. "When you perform a total lobectomy or take out the whole lobe people sometimes mistakenly refer to that as a total thyroidectomy. There's also considerable confusion about what subtotal thyroidectomies and lobectomies are and how they differ from total or partial procedures."
When only [...]
