Wiki Thyroglossal duct cyst

AN2114

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I would like an opinion on this report. The op note says excision midline neck mass but the doctor told me it is an excision of the thyroglossal duct cyst. So I was wondering if I have enough info to where I can bill it for the 60280 code. It does not specifically say the thyroglossal duct but from what I read about the procedure some of it sounds like code 60280. Should I use 21555 or can I use 60280?

Procedure: Excision midline neck mass and primary complex midline neck mass closure

Procedure Details: A marking pen was used to mark the midline incision site. 2cc of 1% lidocaine with 1:100,000 epinephrine was injected into the planned incision line. The surgical site was then prepped and draped in the normal sterile fashion. Using a 15 blade a 2cm incision was performed carried through the epidermis and dermis. A needle tip bovi on a setting of 8 was used to cauterize the bleeding. Using addison pickups and an iris scissor the subcutaneous fat and platysma muscle was carefully dissected and the capsule of the midline neck mass was encountered. The circumference of the midline neck was completely dissected free of superficial muscle tissue carried down to the level of the tracheolaryngeal fascia. Extreme care was taken to ensure no sinus tract was present between the midline neck mass and the hyoid bone. Care was then taken to completely dissect the midline neck mass off of the tracheolaryngeal fascia and it was removed in its entirety from the fascia bed. The midline neck mass was found to be 2.0cm x 2.0cm in size with a defect spanning a 3.0cm x 3.0cm in size. The muscle bed was irrigated copiously with saline and a valsalva was performed to 20. No additional bleeding was visualized. Three 5-0 PDS sutures were placed to approximate the deep layers and a running subcutaneous closure was performed using 5-0 monocryl sutures. Dermabond was placed over the superficial skin surface and steri strips were placed over the incision site. Patient was then cleaned of iodine and care of patient returned to the anesthesia team who extubated the patient without complication. Patient was taken to PACU in stable condition.
 
From reading the note, I would go with 21556, Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); less than 5 cm, Manders21. The surgeon went down to fascia and muscle for the removal of the tumor.

Below is the Lay Description and clinical responsibility for 60280. Reading it, I tend to side with 21556 instead:
60280
Lay Description

The provider removes a thyroglossal duct cyst. A thyroglossal duct cyst is a cyst in the midline of the neck caused by a segment of the thyroglossal duct that did not close or disappear during embryonic development. The procedure is done to prevent infection, a recurrence of the cyst, or malignancy.

Clinical Responsibility
When the patient is appropriately prepped and anesthetized, the provider incises the region of the enlarged cyst. She then divides the surrounding muscles to free the cyst, and she ties and cuts the blood vessels. As the thyroglossal tract is closely associated with the hyoid bone, she cuts and removes the middle portion of the bone. Next, she incises a small cone of muscle from the base of the tongue to free the thyroglossal tract and removes the cyst and tract together. She repairs the tongue muscle, packs the wound, places a drain, and closes the incision.
 
From reading the note, I would go with 21556, Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); less than 5 cm, Manders21. The surgeon went down to fascia and muscle for the removal of the tumor.

Below is the Lay Description and clinical responsibility for 60280. Reading it, I tend to side with 21556 instead:
60280
Lay Description

The provider removes a thyroglossal duct cyst. A thyroglossal duct cyst is a cyst in the midline of the neck caused by a segment of the thyroglossal duct that did not close or disappear during embryonic development. The procedure is done to prevent infection, a recurrence of the cyst, or malignancy.

Clinical Responsibility
When the patient is appropriately prepped and anesthetized, the provider incises the region of the enlarged cyst. She then divides the surrounding muscles to free the cyst, and she ties and cuts the blood vessels. As the thyroglossal tract is closely associated with the hyoid bone, she cuts and removes the middle portion of the bone. Next, she incises a small cone of muscle from the base of the tongue to free the thyroglossal tract and removes the cyst and tract together. She repairs the tongue muscle, packs the wound, places a drain, and closes the incision.
Thank you!!
 
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