# Thyroid Coding....HELP!!!



## AthensCoder (Jan 5, 2012)

Need help with the CPT codes for following OP report: It is very lengthy,,, I'm thinking 60240 & 38724 59.

Pre/Post Op Dx: Metastatic papillary cancer of the thyroid.

Procedure:
1. Total thyroidectomy
2. Central node neck dissection
3. Excision of bilateral internal jugular cervical nodes

A low transverse cervical incision was made and was carried through the underlying platysma muscle. Superior and inferior flaps were created deep to the platsyma muscle. The strap muscles were divided longitudually along the midline. The patient has what appears to be a multifocal papillary cancer of the thyroid mostly involving the isthmus and the left lobe. The right thyroid appearded relatively sparred. The vasculature of the isthmus was divide with harmonic scissors. The superior pole vessels on the left side were divided using harmonic scissors. Teh superior parathyroid gland was identified, dissected off the gland and allowed to retractlaterrally. Teh recurrent laryngeal nerve was identified, traced to its entry in the cricopharyngeus muscle. It was traced inferiorly and inferiorly there was a cluster of nodes surrounding the receurrent laryngeal nerve. These were dissected free and excised. Berry's ligament was divided with the recurrent laryngeal nerve protected. The inferior parathyroid gland was identified and left undisturbed. The central nides on the left side were dissected inferiorly to the anterior mediastinum and dissected as far distally as I could excise. These were excised with plans for doing so in a contiguous fashion but in essence they were excised and sent with the specimen, but seperate. The were palpable nodes within the anterior medistinum that were beyond the the scope of central neck dissection. On the left side the superior pole vesselss were divided. the left superior and inferior parathyroid glands were identified and dissected. The recurrent larygneal nerve was identified, and dissected, and traced to its entry into the cricopharyngeus musclenad was left undisturbed. There were no clinically palpable nodes on the right side. Teh gland was then dissected off the anterior aspect of the trachea and was excised in its entirety.

Attention was then turned to the palpable jugular chain nodes. The corotid sheath was entered on the left side. The vagus nerve was actually found on the posterior aspect of the node with the node compressing the jugular vein posteriorly. This was tediously dissected free from the surrounding structures and excissed using harmonic scissors. Whre the node had previous needle biopsy, it was up underneath the sternocleidomastoid muscle, this was scarred abd the capsule was ruptured in the attemption to dissect this off. This was dissected in its entirety. There were no other palpablenodes obvous within this chain and given the fact that this is clearly not a curative resection, the discion was made not to perform a formal neck dissection. On the right side involved node was predominantly cystic and proved to be the lateral aspect of the jugular vein. It was dissected free fromt he surrounding structures and excised in its entirety. A Jackson-Pratt drain was placed and brought out through an inferior stab wound.... 

Thanks In Advance!
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## ajs (Jan 5, 2012)

AthensCoder said:


> Need help with the CPT codes for following OP report: It is very lengthy,,, I'm thinking 60240 & 38724 59.
> 
> Pre/Post Op Dx: Metastatic papillary cancer of the thyroid.
> 
> ...



I was thinking the second procedure maybe should be 38542 "Dissection deep jugular nodes" instead and you don't need a 59 modifer.  You could use the 51 modifier if you want.  The note said "the decision was made not to perform a formal neck dissection" that is why I think the 38724 "Cervical lymphadenectomy (modified radical neck dissection)" is not correct.


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## AthensCoder (Jan 6, 2012)

I see what you are saying. Thank you for your help. I posted this in another thread and no one out of 98
coders had any answers or opinions, so you help is greatly appreciated.


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## ekeylor (Jan 6, 2012)

Have you looked at 60254 for the first code since it is for malignancy?


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