• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki central and left sided neck dissection

Create Wiki
S

sksmith31

Contributor
Messages
20
Location
hot springs, AR
Best answers
0
can someone help with a code?
Per OP note:
Central and left-sided neck dissection with 3 or 4 small lymph nodes
Using the LigaSure some fibrofatty tissue in the left neck and medially over the trachea was taken with care being taken to stay away from the nerve and the presumed left inferior parathyroid. The specimen was submitted as central neck dissection.

Response from physician:
these are central, not jugular nodes. I do not think they are classified as a level which applies to jugular nodes along the jugular vein. Technically central nodes are level 6 nodes but this is a standard dissection performed for thyroid lesions only
I was looking at CPT 38700
 
1. Left hemithyroid, lobectomy:
Benign thyroid lobe with hyperplastic nodule and chronic thyroiditis.
Negative for neoplasia.
Incidental portion of parathyroid gland (2 mm) tissue present on histologic section.
2. Central neck dissection:
One of five lymph nodes containing metastatic papillary thyroid carcinoma (1/5).
See comment.
Comment:

Pathologic stage classification requires outside facility pathology data. Part 2 central neck dissection alone is pN1a.

This is path
 
sksmith31 said:
1. Left hemithyroid, lobectomy:
Benign thyroid lobe with hyperplastic nodule and chronic thyroiditis.
Negative for neoplasia.
Incidental portion of parathyroid gland (2 mm) tissue present on histologic section.
2. Central neck dissection:
One of five lymph nodes containing metastatic papillary thyroid carcinoma (1/5).
See comment.
Comment:

Pathologic stage classification requires outside facility pathology data. Part 2 central neck dissection alone is pN1a.

This is path
Click to expand...
per your path he removed lt thyroid ?? but i dont see that documented, if documentation was better it may be 60252 includes neck dissection but his documentation is very lax for proper coding
 
No he did not do a total thyroid, he did a left thyroidectomy 60220, I just didnt post that part.

Here is the whole op note:
Procedure: left thyroid lobectomy and central neck dissection

Anesthesia: GETA

Findings:
Left thyroid lobe removed intact
Left superior parathyroid preserved
Left inferior parathyroid felt to be out in the lateral fatty tissue and left undisturbed
Recurrent laryngeal nerve identified and preserved into the thoracic inlet
Central and left-sided neck dissection with 3 or 4 small lymph nodes


Specimens Removed: left thyroid lobe and contents of the central neck dissection


Pre-procedure note: who has undergone a previous right hemithyroidectomy which was found to have a papillary carcinoma. She has been seen by oncology and endocrinology and she is elected to proceed with total thyroidectomy. The patient understands the risks of bleeding into the neck with subsequent airway compromise, infection, and damage to the recurrent and superior laryngeal nerves which could lead to weakness of the voice, aspiration, or even tracheostomy. The patient understands the risk of damage to the parathyroid glands which could result in significant drop in calcium which could require replacement, possibly even for life. She understands these risks are increased somewhat if she is having redo neck surgery consent has been obtained.

Procedure note: The patient was taken to the OR and administered GETA. The neck was extended and prepped and draped in a sterile fashion. A curvilinear incision was made, the platysma was divided and subplatysmal flaps were developed more so on the left side than the right side. The strap muscles were divided in the midline exposing the left-sided thyroid gland.
There are only thin unnamed venous structures and no true middle thyroid vein on the left. All of this was taken down with LigaSure and the loose areolar tissue was bluntly dissected away from the thyroid allowing identification of the entirety of the thyroid lobe.
The superior pole vasculature was addressed and dissected next to the thyroid gland. 2 or 3 separate bundles of vessels were taken with ties and secured with clips. Addressing the inferior pole of the thyroid there was a large unnamed vein emanating from the thoracic inlet which was clipped and tied and divided in a smaller vein next to this it was likewise taken. This allowed the inferior pole of the mobilized using the LigaSure. The superior pole and the inferior pole were then mobilized to the midportion of the thyroid gland next to the trachea and then dissection demonstrated the ITA pedicle which was traced to superior parathyroid gland adherent to the superior portion of the thyroid. Careful dissection freed this gland preserving its blood supply. Under the ITA pedicle the recurrent laryngeal nerve was then identified and was dissected retrograde all the way down to the thoracic inlet preserving and identifying its course. During the course of this dissection a branch of the ITA was noted to be proceeding inferiorly into a globule of fat where the inferior parathyroid gland was suspected to be. This was left undisturbed.
Dissection next to the thyroid gland next to the trachea was then done using a combination of the LigaSure the Bovie endoclips preserving the ITA pedicle and the recurrent laryngeal nerve until it entered the voicebox. The rest of the thyroid remnant was then removed from the trachea using the LigaSure and was submitted.
Using the LigaSure some fibrofatty tissue in the left neck and medially over the trachea was taken with care being taken to stay away from the nerve and the presumed left inferior parathyroid. The specimen was submitted as central neck dissection.
The straps, platysma, and skin were closed with dexon. Glue was applied. The patient was returned to the RR after tolerating the procedure well. Estimated blood loss was minimal, and sponges and instruments were accounted for.

Estimated Blood Loss: Minimal
 
sksmith31 said:
60252 is for a total thyroid, this patient already had the RT side removed
Click to expand...
you could use
60220 lt
38999 compare to 38724-52 (less work )

or 60252-52 with explanation of previous work on RT now removing remainder of thyroid on left with additional tissue removal

or you could check with your facility and see how they billed
 
You must log in or register to reply here.
Top