Otolaryngology Coding Alert

Functional, selective, radical refer to the same procedure.

Nine codes and five terms can challenge your thyroidectomy and neck dissection coding accuracy. See if you have the skills necessary to submit these scenarios accurately.

Include Some Dissections in 60240-60271

When coding for thyroidectomy (60240-60271), keep a close eye on the code descriptors. "Many of them include all of the procedures that the otolaryngologist performed, so you won't have to report additional codes for the auxiliary services," says Barbara J. Cobuzzi, MBA, CPC, CPCH, CPC-P, CENTC, CHCC, president of N.J.-based CRN Healthcare Solutions.

Example 1: Your otolaryngologist removes both thyroid lobes with the isthmus and pyramid lobe tissue. He also identifies and excises all enlarged lymph nodes. The malignancy has not spread significantly, so the otolaryngologist excises only a few selected lymph nodes. He ultimately performs a thyroidectomy with limited neck dissection.

Solution 1: You should report only 60252 (Thyroidectomy, total or subtotal for malignancy; with limited neck dissection). This code includes reimbursement for the thyroidectomy and the limited dissection.

Example 2: During a total thyroidectomy, an otolaryngologist dissects all the levels of lymph nodes and must sacrifice the spinal accessory nerve, jugular vein and sternocleidomastoid muscles to remove a malignant lymphatic chain.

Solution 2: In this case, report only the thyroidectomy with radical neck dissection with 60254 (Thyroidectomy, total or subtotal for malignancy; with radical neck dissection). By definition, you shouldn't separately report the radical neck dissection (38720, Cervical lymphadenectomy [complete]).

Look to 38724 for Modified Radical

CPT, however, throws you a curve ball when your physician combies thyroidectomy with modified radical neck dissection, the procedure performed with malignancies. None of the thyroidectomy codes specify this combination, which you'll have to code out separately.

Example 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.

Solution 3: Because CPT doesn't include a code for the thyroidectomy with modified radical neck dissection, you should report 60240 (Thyroidectomy, total or complete) with 38724 (Cervical lymphadenectomy [modified radical neck dissection]). In a modified radical neck dissection, the surgeon dissects levels II through V of the lymph nodes on one side of the neck but spares the sternocleidomastoid muscle, the spinal accessory nerve, and the jugular vein. If the physician performs a neck dissection on both sides of the neck, make sure you code it with modifier 50, which will indicate to the payer that it was a bilateral procedure (38724-50)

Watch Out for Other Terms

Although op report titles clue you into how to code a procedure, otolaryngologists may use several monikers for a modified radical neck dissection.

Example 4: Many coders ask what the code is for a functional neck dissection.

Solution 4: "Functional neck dissection is the same as a modified radical neck dissection," Cobuzzi says. Another name your surgeon might use is selective neck dissection. The code for these is 38724.

Surprise: You may have trouble finding "neck dissections" in the CPT manual, because, instead of "neck dissections," CPT uses the terminology "lymphadenectomies," which fall under three codes:

Example 5: An otolaryngologist removes the lymph nodes as well as the sternocleidomastoid muscle, the spinal accessory nerve, and the internal jugular vein.

Solution 5: This is a radical neck dissection (38720). Note that you should report 38700 when the surgeon removes the nodes above the thyoid only.