Parathyroidectomy:
Dos and Don'ts
Published on Mon Oct 01, 2001
Updated on Mon Oct 01, 2001
The parathyroids comprise a number of glands that sit underneath and, sometimes, within the thyroid gland. The number of parathyroid glands in individuals varies from two to six. Whereas the thyroid regulates the body's metabolism, the parathyroids control the body's calcium level.
Because the parathyroids are so close to the thyroid, they are often removed when a thyroidectomy is performed to remove malignancy. In such cases, the removal of the parathyroids is incidental to the thyroid excision and is not separately payable. At other times, the otolaryngologist, while performing a parathyroidectomy, finds a lesion on the thyroid gland that requires biopsy and/or excision. In these instances, the parathyroidectomy and the resulting thyroid excision procedure are both payable separately.
Also, after performing a parathyroidectomy, the otolaryngologist may transplant some of the parathyroid gland to a different anatomic site to preserve its function. This procedure, known as parathyroid autotransplantation, is payable separately even when thyroidectomy is also performed and the parathyroidectomy is included in the larger procedure.
The following codes describe parathyroid procedures:
60500 parathyroidectomy or exploration of parathyroid(s)
60502 re-exploration
60505 with mediastinal exploration, sternal split or transthoracic approach
60512 parathyroid autotransplantation (list separately in addition to code for primary procedure).
Often, otolaryngologists remove three or 3 1/2 of the patient's four parathyroid glands, leaving one gland (or at least some tissue from one gland) to retain parathyroid function and prevent hypoparathyroidism.
Code 60500 is used to report total and partial parathyroidectomies, says Sanford Archer, MD, an associate professor of otolaryngology at the University of Kentucky's College of Medicine in Lexington and chairman of the patient safety and quality improvement committee of the American Academy of Otolaryngology.
"The parathyroid organs are so small, the physician may believe they have all been excised, when, in fact, some tissue may have been left behind," he says. Either way, because parathyroid surgery can be quite meticulous, 60500 is also used to report parathyroid explorations.
When performing total thyroidectomies, otolaryngologists have to be careful to leave some parathyroid tissue so some function can be maintained. "The otolaryngologist tries to avoid removing parathyroid tissue unnecessarily (for example, if it is free of malignancy)," Archer says.
The parathyroidectomy should not be billed separately, because 60500, 60502 and 60505 are bundled with most thyroidectomy procedures in the national Correct Coding Initiative (CCI).
There are important exceptions. Sometimes, for instance, the otolaryngologist may find an unusual lesion on the thyroid during a parathyroidectomy for a malignant tumor. This occurs fairly often because thyroid pathology, although common, [...]
