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Hi my fellow coders
I am hoping someone could help me with a cpt code. I found the perfect code for what he did cpt 60252 BUT there was no malignancy. I sent the surgeon a message to see if 38700, 38720 or 38724 would apply and he said no these codes do not apply. I then told him I could bill the total thyroidectomy and add the 22 modifier and he disagrees. He thinks there should be a code for the limited neck dissection. I am attaching the op report and if anyone out there could help me I would greatly appreciate it.
Thank you
Anne Domagata, cpc, cgic
email: ADomagata@paloshealth.com
Operation: Procedure(s):
1. TOTAL THYROIDECTOMY
2. LEFT CENTRAL NECK DISSECTION
3. AUTOTRANSPLANT OF LEFT INFERIOR PARATHYROID INTO LEFT SCM
Preoperative Diagnosis: Thyromegaly with symptoms of compression, non-toxic multinodular goiter
*
Post-op Diagnosis: Thyromegaly with symptoms of compression, non-toxic multinodular goiter
Procedure Details: The patient was placed supine on the operating room table. Bilateral sequential compressive devices were applied to the lower extremities. General anesthesia was induced. A special ET tube used for monitoring of vocal cord function during surgery was placed. The patient was placed in a "beach chair" position with a shoulder roll, arms tucked at the sides, and head extended with appropriate support. The neck was then prepped and draped in the usual sterile fashion. Antibiotics were infused prior to incision.
**
A 6 cm transverse cervical incision was made in a natural skin fold and carried down through the subcutaneous tissue and the platysma.*Superior and inferior subplatysmal flaps were created. The avascular plane between the strap muscles was identified and separated in the midline to enter into the central compartment.
*
The dissection was first directed towards the left side. The superior pole and the space between the superior pole and the cricothyroid muscle were dissected. Branches of the superior pole vessels as they entered into the thyroid gland were ligated and divided with the Ligasure device. The superior pole was carefully mobilized and the gland rotated medially exposing the posterolateral aspect of the gland. With the gland in this position, the left recurrent laryngeal nerve was identified. The superior parathyroid gland along with its vascular blood supply was identified and preserved. A lymph node in close proximity to the left superior parathyroid was sent for frozen section to ensure it was not parathyroid tissue. The inferior pole was mobilized in a similar manner. The left inferior parathyroid was identified, but had a tenuous blood supply after mobilizing it off the thyroid. A tiny amount of tissue was sent as a frozen section to confirm it was in fact parathyroid tissue. A second lymph node in close proximity was also sent for frozen section. Next, the medial thyroid attachments were divided. 4-0 silk ligasures were used when they were in close proximity to the nerve. The ligament of Berry was divided and the remaining thyroid tissue was lifted off the trachea, including the isthmus and pyramidal lobe.* Of note, dissection of the left thyroid lobe was difficult as it was very adherent, although not invading, the surrounding tissue. A considerable amount of left central neck lymphadenopathy was also identified. Given these findings, I proceeded with performing a left central neck dissection in the standard fashion. Attention was then turned to the right side of the neck.* The strap muscles were retracted laterally and the right lobe was removed in a similar manner.* The right superior and inferior parathyroid glands, along with their vascular blood supply, were identified and preserved. All specimens were submitted to pathology.*
*
The Nerveana nerve monitoring system was used to confirm function of both recurrent laryngeal nerves during and at the end of the procedure. The wound was irrigated with water and inspected carefully for any bleeding. Hemostasis was assured prior to closing. The parathyroid tissue was checked using PinPoint and the parathyroids were found to be viable and in their anatomical locations except for the left inferior parathyroid. The left inferior parathyroid was excised, sectioned into small pieces, autotransplanted into the left SCM, and marked with 2-0 Prolene stitch. The strap muscles were re-approximated in the midline. The subcutaneous tissue was infiltrated with 0.25% bupivacaine with epinephrine. The platysma was closed with interrupted 4-0 Vicryl suture and the skin incision was re-approximated with a running subcuticular suture of 4-0 Vicryl.* Dermabond was applied to the incision. The patient was awakened, extubated, and taken to the recovery room in stable condition.* At the end of the operation all sponge, instrument and needle counts were correct.
*
Operative Findings: Central neck lymphadenopathy, greater in left level VI
I am hoping someone could help me with a cpt code. I found the perfect code for what he did cpt 60252 BUT there was no malignancy. I sent the surgeon a message to see if 38700, 38720 or 38724 would apply and he said no these codes do not apply. I then told him I could bill the total thyroidectomy and add the 22 modifier and he disagrees. He thinks there should be a code for the limited neck dissection. I am attaching the op report and if anyone out there could help me I would greatly appreciate it.
Thank you
Anne Domagata, cpc, cgic
email: ADomagata@paloshealth.com
Operation: Procedure(s):
1. TOTAL THYROIDECTOMY
2. LEFT CENTRAL NECK DISSECTION
3. AUTOTRANSPLANT OF LEFT INFERIOR PARATHYROID INTO LEFT SCM
Preoperative Diagnosis: Thyromegaly with symptoms of compression, non-toxic multinodular goiter
*
Post-op Diagnosis: Thyromegaly with symptoms of compression, non-toxic multinodular goiter
Procedure Details: The patient was placed supine on the operating room table. Bilateral sequential compressive devices were applied to the lower extremities. General anesthesia was induced. A special ET tube used for monitoring of vocal cord function during surgery was placed. The patient was placed in a "beach chair" position with a shoulder roll, arms tucked at the sides, and head extended with appropriate support. The neck was then prepped and draped in the usual sterile fashion. Antibiotics were infused prior to incision.
**
A 6 cm transverse cervical incision was made in a natural skin fold and carried down through the subcutaneous tissue and the platysma.*Superior and inferior subplatysmal flaps were created. The avascular plane between the strap muscles was identified and separated in the midline to enter into the central compartment.
*
The dissection was first directed towards the left side. The superior pole and the space between the superior pole and the cricothyroid muscle were dissected. Branches of the superior pole vessels as they entered into the thyroid gland were ligated and divided with the Ligasure device. The superior pole was carefully mobilized and the gland rotated medially exposing the posterolateral aspect of the gland. With the gland in this position, the left recurrent laryngeal nerve was identified. The superior parathyroid gland along with its vascular blood supply was identified and preserved. A lymph node in close proximity to the left superior parathyroid was sent for frozen section to ensure it was not parathyroid tissue. The inferior pole was mobilized in a similar manner. The left inferior parathyroid was identified, but had a tenuous blood supply after mobilizing it off the thyroid. A tiny amount of tissue was sent as a frozen section to confirm it was in fact parathyroid tissue. A second lymph node in close proximity was also sent for frozen section. Next, the medial thyroid attachments were divided. 4-0 silk ligasures were used when they were in close proximity to the nerve. The ligament of Berry was divided and the remaining thyroid tissue was lifted off the trachea, including the isthmus and pyramidal lobe.* Of note, dissection of the left thyroid lobe was difficult as it was very adherent, although not invading, the surrounding tissue. A considerable amount of left central neck lymphadenopathy was also identified. Given these findings, I proceeded with performing a left central neck dissection in the standard fashion. Attention was then turned to the right side of the neck.* The strap muscles were retracted laterally and the right lobe was removed in a similar manner.* The right superior and inferior parathyroid glands, along with their vascular blood supply, were identified and preserved. All specimens were submitted to pathology.*
*
The Nerveana nerve monitoring system was used to confirm function of both recurrent laryngeal nerves during and at the end of the procedure. The wound was irrigated with water and inspected carefully for any bleeding. Hemostasis was assured prior to closing. The parathyroid tissue was checked using PinPoint and the parathyroids were found to be viable and in their anatomical locations except for the left inferior parathyroid. The left inferior parathyroid was excised, sectioned into small pieces, autotransplanted into the left SCM, and marked with 2-0 Prolene stitch. The strap muscles were re-approximated in the midline. The subcutaneous tissue was infiltrated with 0.25% bupivacaine with epinephrine. The platysma was closed with interrupted 4-0 Vicryl suture and the skin incision was re-approximated with a running subcuticular suture of 4-0 Vicryl.* Dermabond was applied to the incision. The patient was awakened, extubated, and taken to the recovery room in stable condition.* At the end of the operation all sponge, instrument and needle counts were correct.
*
Operative Findings: Central neck lymphadenopathy, greater in left level VI