Partial thyroid lobectomy

[calexander1265]

I have a surgeon who is charging for 60210 and 60500. The 60210 is being denied as duplicate or included in the 60500. I have not found a cci or mutially exclusive edit for these codes. Is it appropriate to bill for both of these procedures?

 

[jmcpolin]

as far as I can tell 60500 is for the parathyroid glands adjacent to the thyroid and 60210 is for the thyroid, is he removing both?

 

[Lujanwj]

There shouldn't be a problems as long as the partial lobectomy and the parathyroidectomy were done on separate surgical sites. If the part of the lobe dr excised contained a parathyroid it could be considered incidental to the lobectomy. The payor might also be thinking that a bit of the lobe might be excised in order to do a parathyroidectomy. That's probably why they paid 60500. I'd appeal if I can show separate and distinct locations. If I can't show separate, my argument would be that there's no NCCI Edit.

Remember, when doing a thyroidectomy the parathyroidectomy is included per NCCI.

https://www.cms.gov/MedicaidNCCICoding/Downloads/gencorrlang.pdf

Correspondence Language Policy/Example Number 10.60000 - Standards of medical/surgical practice

For example, CPT code 60240 describes a total or complete thyroidectomy. CPT code 60500 describes a parathyroidectomy or exploration of parathyroid(s). The exploration of parathyroid glands with or without parathyroidectomy (CPT code 60500) is standard surgical practice when performing a complete thyroidectomy (CPT code 60240). Therefore, CPT code 60500 is bundled into CPT code 60240.

Good Luck!

 

[calexander1265]

The dictation states:
1. Excision of parathyroid adenoma from left upper position
2. Removal of left lower parathyroid
3. Biopsy of thyroid cyst
4. Partial lobectomy with removal of large hyperplastic lower parathyroid nodule from mediastinal area.

So I was of the opinion that only the 60500 would be billed, am I incorrect and is there some other way this should be coded?