AN2114
Guru
The doctor said he did a tracheal fenestration with skin flaps and midline thyroid isthmusectomy. I know the cpt code for the tracheal fenestration is 31610 and based on the details I believe the cpt code for the isthmusectomy would be 60200 since the details say transected but I want to make sure that is correct, or would I use cpt code 60210. And I don't see 31610 or 60200 or 60210 in the NCCI edits but is an isthmusectomy included in a tracheal fenestration with skin flaps? Here is the op report:
Procedure:
Tracheal fenestration with skin flaps
midline thyroid isthmusectomy
tracheostomy tube placement
flexible tracheoscopy
Procedure details:
Patient brought into OR suite and transferred to the operative table. Anesthesia team induced anesthesia and turned over to ENT. Neck was prepped and draped in a sterile fashion. Landmarks including sternal notch, cricoid and hyoid identified. 1cc of 1% lidocaine with 1:100,000 epinephrine was injected into the anticipated incision site. Transverse incision was made below the cricoid and roughly 1 cm above the sternal notch. Dissection carried through skin and into subcutaneous fat and skin flaps elevated. Small lipectomy was performed to remove excessive pretracheal fat. Subcutaneous flaps created. Strap muscles were then lateralized and thyroid isthmus was transected and lateralized. Once this was done the trachea was identified and two 4-0 silk suture were placed on the lateral sides and secured to the thorax using mastisol and tape. Tracheal fenestration was created by making an incision through the 2nd and third tracheal ring in a vertical manner. Tracheostomy tube was then placed. Position was then confirmed with flexible tracheoscopy viewing the carina 1 cm below the lower portion of the tube. Flanges were secured with ties. Patient turned over to anesthesia who was transferred to ICU bed and taken to ICU in stable condition.
Procedure:
Tracheal fenestration with skin flaps
midline thyroid isthmusectomy
tracheostomy tube placement
flexible tracheoscopy
Procedure details:
Patient brought into OR suite and transferred to the operative table. Anesthesia team induced anesthesia and turned over to ENT. Neck was prepped and draped in a sterile fashion. Landmarks including sternal notch, cricoid and hyoid identified. 1cc of 1% lidocaine with 1:100,000 epinephrine was injected into the anticipated incision site. Transverse incision was made below the cricoid and roughly 1 cm above the sternal notch. Dissection carried through skin and into subcutaneous fat and skin flaps elevated. Small lipectomy was performed to remove excessive pretracheal fat. Subcutaneous flaps created. Strap muscles were then lateralized and thyroid isthmus was transected and lateralized. Once this was done the trachea was identified and two 4-0 silk suture were placed on the lateral sides and secured to the thorax using mastisol and tape. Tracheal fenestration was created by making an incision through the 2nd and third tracheal ring in a vertical manner. Tracheostomy tube was then placed. Position was then confirmed with flexible tracheoscopy viewing the carina 1 cm below the lower portion of the tube. Flanges were secured with ties. Patient turned over to anesthesia who was transferred to ICU bed and taken to ICU in stable condition.
you would actually code for the 31610 alone for the tracheostomy with fenestration flaps. The thyroid isthmus lies generally above the 3rd and 4th rings of the trachea so sometimes during a tracheostomy placement, they will transect (or cut through) and then move the thyroid isthmus out of the way (aka lateralize it or move it to the side). When this happens, they aren't actually removing the isthmus or any part of the thyroid due to disease but are instead getting it out of the way so they can access the trachea. For this reason, the transection of the isthmus becomes part of the approach to the tracheostomy and is considered part of that main procedure coded with 31610 or 31600.