lngreen1107
New
Hi! This is my first time posting. I currently work for a multi-specialty clinic doing charge entry (I'm newly CPC-A certified), and am supposed to be somewhat auditing codes chosen by the physicians as I enter charges.
We have an Endocrinologist in our group who sees patients for post-operative hypothyroidism usually following diagnosis of malignant neoplasm of thyroid gland (C73). My question is this: The doctor states she is still technically surveilling patients for a return of cancer even decades after complete thyroidectomy, which is why she continues to code with the C73 in addition to the post-operative hypothyroidism. I have concerns regarding use of this code when the patient no longer has their thyroid and is not receiving active treatment. At what point do we switch to a "history of" code or is there another appropriate code to use? She is still ordering labs based off of this previous cx diagnosis and the surgery to remove it. Is this correct?
Example 1: Patient had total thyroidectomy in 2013 for papillary thyroid cx. Path report mentions margins uninvolved w/ cx and with no lymphovascular invasion. No lymph nodes involved. She has had whole body scans done afterwards, none with any evidence of metastatic disease. She received iodine ablation, unk exact dose. We still order thyroglobulin levels and ultrasounds in reference to this occurrence.
Example 2: Patient had total thyroidectomy in 2015, negative lymph nodes. Low risk of relapse. Patient decided not to receive radioactive iodine and just monitor. Excellent response to tx. We still order thyroglobulin levels and ultrasounds in reference to this occurrence.
Example 3: Patient was operated on in 2017. No lymphovascular invasion. Whole body scan shows no evidence of metastasis. Low risk of relapse. Ultrasound of neck in Feb showed no tissue in thyroid bed and no lymphadenopathy.
Please give me an idea of how this should be coded. At current she is coding E89.0 and C73.
Thanks for your help!
We have an Endocrinologist in our group who sees patients for post-operative hypothyroidism usually following diagnosis of malignant neoplasm of thyroid gland (C73). My question is this: The doctor states she is still technically surveilling patients for a return of cancer even decades after complete thyroidectomy, which is why she continues to code with the C73 in addition to the post-operative hypothyroidism. I have concerns regarding use of this code when the patient no longer has their thyroid and is not receiving active treatment. At what point do we switch to a "history of" code or is there another appropriate code to use? She is still ordering labs based off of this previous cx diagnosis and the surgery to remove it. Is this correct?
Example 1: Patient had total thyroidectomy in 2013 for papillary thyroid cx. Path report mentions margins uninvolved w/ cx and with no lymphovascular invasion. No lymph nodes involved. She has had whole body scans done afterwards, none with any evidence of metastatic disease. She received iodine ablation, unk exact dose. We still order thyroglobulin levels and ultrasounds in reference to this occurrence.
Example 2: Patient had total thyroidectomy in 2015, negative lymph nodes. Low risk of relapse. Patient decided not to receive radioactive iodine and just monitor. Excellent response to tx. We still order thyroglobulin levels and ultrasounds in reference to this occurrence.
Example 3: Patient was operated on in 2017. No lymphovascular invasion. Whole body scan shows no evidence of metastasis. Low risk of relapse. Ultrasound of neck in Feb showed no tissue in thyroid bed and no lymphadenopathy.
Please give me an idea of how this should be coded. At current she is coding E89.0 and C73.
Thanks for your help!