Intraoperative Ultrasound during Thyroidectomy

[ljones88]

Hi all,

In all my 7 years of coding for ENT, this is the first time I'm coming across this and I wanted to know if what is being done is tip-toeing on the edge of over-utilization or not medically necessary....

Endo surgeon performs thyroidectomies and lobectomies all the time without any intraoperative ultrasound. All of the sudden now EVERY single case has included 76536 (Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation) and I'm concerned that this is not medically necessary. I haven't been able to find a single scholarly article, coding article, or even Physician membership board mentioning that this is somehow routine (or even a new way of performing the surgery). I've worked with 2 different ENT groups and this is the first time I'm seeing them bill for 76536; 1-2 cases here and there, I can understand...this is literally every single patient on their list all of sudden.

Most of the documentation is verbatim in every op report and reads: "After induction of general endotracheal anesthesia, Intraoperative neck sonography was performed for incision site planning and to rule out interval development of malignant adenopathy or extrathyroidal extension of tumor. The patient was then prepped..."

[garcia06]

Hello, I've asked a network coding and this is the response

Which code is the proper one to bill for in this scenario please
After induction of general endotracheal anesthesia, Intraoperative neck sonography was performed for incision site planning and to rule out interval development of malignant adenopathy or extrathyroidal extension of tumor CPT 76998. or 76536.

Response
Cpt code 76998 seems more appropriate for the above scenario as per the given codes.

Hope this helps !

[mgord]

Hi all,

In all my 7 years of coding for ENT, this is the first time I'm coming across this and I wanted to know if what is being done is tip-toeing on the edge of over-utilization or not medically necessary....

Endo surgeon performs thyroidectomies and lobectomies all the time without any intraoperative ultrasound. All of the sudden now EVERY single case has included 76536 (Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation) and I'm concerned that this is not medically necessary. I haven't been able to find a single scholarly article, coding article, or even Physician membership board mentioning that this is somehow routine (or even a new way of performing the surgery). I've worked with 2 different ENT groups and this is the first time I'm seeing them bill for 76536; 1-2 cases here and there, I can understand...this is literally every single patient on their list all of sudden.

Most of the documentation is verbatim in every op report and reads: "After induction of general endotracheal anesthesia, Intraoperative neck sonography was performed for incision site planning and to rule out interval development of malignant adenopathy or extrathyroidal extension of tumor. The patient was then prepped..."

Did you ever get a resolution to this issue? I have always coded 60220 but am seeing 76536 coded by the provider. Thanks!

[ASH527]

code 76998 in for intraoperative and my surgeons do the same as well. I always check cci edits to be sure that it is appropriate to bill.