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RT Thyroid lobectomy and Isthusectomy

  1. Default RT Thyroid lobectomy and Isthusectomy
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    Hello,
    Can someone tell me how do you decipher or what terminology in the op report flags a total( 60220) or a partial (60210) or a contralateral/opposite (60212/60225)? I know from reading the description of the code 60220 (total), the inferior and superior vessels are ligated and the isthmus is severed. I belive this is a total, but a little unsure. Please let me know after reading the following : Thanks!

    A small transverse skin incision was made in the lower neck. Sharp dissection
    was carried down through the skin and subcutaneous tissues.
    Hemostasis was strict and achieved with electrocoagulation. The
    platysma was divided. Skin flaps were developed superiorly to the
    thyroid cartilage and inferiorly to the suprasternal notch. Gelpi
    retractors were inserted. The strap muscles were divided in the
    midline using electrocautery. The strap muscles were dissected off
    the right lobe of the thyroid. The loose areolar tissue laterally was
    divided with electrocautery. The thyroid gland was mobilized
    medially. Once the thyroid gland had been mobilized medially,
    dissection was carried towards the tracheoesophageal groove and the
    recurrent laryngeal nerve was identified fairly deep in the neck. The
    middle thyroid vein was occluded with clips and divided so the thyroid
    could be rotated more medial. The inferior pole vessels were divided
    adjacent to the thyroid, taking care to preserve the parathyroid
    gland. The inferior thyroid vessels were divided between clips. The
    recurrent laryngeal nerve was traced superiorly towards the larynx.
    The superior pole vessels were then divided between clips. The
    Harmonic scalpel was also used where necessary when a good amount of
    distance was achieved away from the recurrent laryngeal nerve. The
    upper pole vessels were divided and the thyroid gland was mobilized
    inferiorly. The remainder of the thyroid was dissected off the
    trachea laterally keeping dissection right on the thyroid gland
    itself. Clips were also used where necessary. The isthmus was also
    removed with the right thyroid lobe. The isthmus of the thyroid was
    divided using Harmonic scalpel. The specimen was submitted for frozen
    section. The neck was irrigated with saline. The recurrent laryngeal nerve was again traced from well inferior to the thyroid towards it's insertion to the larynx. The parathyroid glands were preserved.

  2. Default
    This is a unilateral thyroidectomy with isthmusectomy, 60210

    Quote Originally Posted by letisha View Post
    Hello,
    Can someone tell me how do you decipher or what terminology in the op report flags a total( 60220) or a partial (60210) or a contralateral/opposite (60212/60225)? I know from reading the description of the code 60220 (total), the inferior and superior vessels are ligated and the isthmus is severed. I belive this is a total, but a little unsure. Please let me know after reading the following : Thanks!

    A small transverse skin incision was made in the lower neck. Sharp dissection
    was carried down through the skin and subcutaneous tissues.
    Hemostasis was strict and achieved with electrocoagulation. The
    platysma was divided. Skin flaps were developed superiorly to the
    thyroid cartilage and inferiorly to the suprasternal notch. Gelpi
    retractors were inserted. The strap muscles were divided in the
    midline using electrocautery. The strap muscles were dissected off
    the right lobe of the thyroid. The loose areolar tissue laterally was
    divided with electrocautery. The thyroid gland was mobilized
    medially. Once the thyroid gland had been mobilized medially,
    dissection was carried towards the tracheoesophageal groove and the
    recurrent laryngeal nerve was identified fairly deep in the neck. The
    middle thyroid vein was occluded with clips and divided so the thyroid
    could be rotated more medial. The inferior pole vessels were divided
    adjacent to the thyroid, taking care to preserve the parathyroid
    gland. The inferior thyroid vessels were divided between clips. The
    recurrent laryngeal nerve was traced superiorly towards the larynx.
    The superior pole vessels were then divided between clips. The
    Harmonic scalpel was also used where necessary when a good amount of
    distance was achieved away from the recurrent laryngeal nerve. The
    upper pole vessels were divided and the thyroid gland was mobilized
    inferiorly. The remainder of the thyroid was dissected off the
    trachea laterally keeping dissection right on the thyroid gland
    itself. Clips were also used where necessary. The isthmus was also
    removed with the right thyroid lobe.
    The isthmus of the thyroid was
    divided using Harmonic scalpel. The specimen was submitted for frozen
    section. The neck was irrigated with saline. The recurrent laryngeal nerve was again traced from well inferior to the thyroid towards it's insertion to the larynx. The parathyroid glands were preserved.

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