kmartinez
Networker
I would appreciate any help regarding the CPT for Reanastomosis of LT recurrent laryngeal nerve as I can not find anything for it.
Doctor performed
1. Left total thyroid lobectomy (60220)
2. Reanastomosis of left recurrent laryngeal nerve (?)
3. Reimplantation of left superior parathyroid gland (60512)
FINDINGS: Left recurrent laryngeal nerve transected, and primary reanastomosis
performed, left superior parathyroid gland devascularized and reimplanted into
the left sternocleidomastoid muscle and marked with Hemoclips, thyroid gland
enlarged, multinodular, hypervascular and inflamed.
...The gland was very hypervascular multinodular and inflamed, very adherent to surrounding structures. The
recurrent laryngeal nerve was found to be coursing over the anterior aspect of the thyroid gland itself and this was transected while dissecting along the thyroid capsule. The 2 ends of the recurrent laryngeal nerve were identified and tagged. A superior
parathyroid gland was identified and its blood supply was preserved, however, during the case, the thyroid was so hypervascular, this was devascularized while obtaining hemostasis. Therefore, the superior parathyroid gland was removed and morcellized and placed back into the sternocleidomastoid muscle on the left at the end of the case. The typical location of the recurrent laryngeal nerve was dissected carefully and there was no nerve of note in this location; however, the distal end of the recurrent laryngeal nerve was found to be entering into the cricothyroid joint and at this point, it was recognized that the abnormal course of the recurrent laryngeal nerve coursing over the anterior aspect of the thyroid lobe was in fact the recurrent laryngeal nerve. The
left thyroid gland was completely removed using Bovie cautery to divide Berry's ligament and bipolar cautery to divide the isthmus. The left thyroid gland was handed off and the 2 tagged ends of the left recurrent laryngeal nerve were reanastomosed using 9-0 nylon. There was not undue tension on the nerve at this point. There was no identifiable parathyroid tissue on the specimen.
TIA
KM
Doctor performed
1. Left total thyroid lobectomy (60220)
2. Reanastomosis of left recurrent laryngeal nerve (?)
3. Reimplantation of left superior parathyroid gland (60512)
FINDINGS: Left recurrent laryngeal nerve transected, and primary reanastomosis
performed, left superior parathyroid gland devascularized and reimplanted into
the left sternocleidomastoid muscle and marked with Hemoclips, thyroid gland
enlarged, multinodular, hypervascular and inflamed.
...The gland was very hypervascular multinodular and inflamed, very adherent to surrounding structures. The
recurrent laryngeal nerve was found to be coursing over the anterior aspect of the thyroid gland itself and this was transected while dissecting along the thyroid capsule. The 2 ends of the recurrent laryngeal nerve were identified and tagged. A superior
parathyroid gland was identified and its blood supply was preserved, however, during the case, the thyroid was so hypervascular, this was devascularized while obtaining hemostasis. Therefore, the superior parathyroid gland was removed and morcellized and placed back into the sternocleidomastoid muscle on the left at the end of the case. The typical location of the recurrent laryngeal nerve was dissected carefully and there was no nerve of note in this location; however, the distal end of the recurrent laryngeal nerve was found to be entering into the cricothyroid joint and at this point, it was recognized that the abnormal course of the recurrent laryngeal nerve coursing over the anterior aspect of the thyroid lobe was in fact the recurrent laryngeal nerve. The
left thyroid gland was completely removed using Bovie cautery to divide Berry's ligament and bipolar cautery to divide the isthmus. The left thyroid gland was handed off and the 2 tagged ends of the left recurrent laryngeal nerve were reanastomosed using 9-0 nylon. There was not undue tension on the nerve at this point. There was no identifiable parathyroid tissue on the specimen.
TIA
KM