# Total Thyroidectomy



## Ravikirann (Sep 18, 2016)

Dear All,

Help me with the below ot notes. I coded 60252 and 60512. Plz suggest me the codes are correct or not.Our Doctor has performed - Total Thyroidectomy
Total excision of Parathyroids, and re-implantation of parathyroid.

Patient in supine position.
Collar incision at a lower neck crease; which was predetermined preoperatively.
The platysma is divided at a higher level than the skin. The flaps of the skin
 and superficial fascia as well as the platysma and then reflected upwards
 to the level of the thyroid cartilage, and downwards to the sternum.
The anterior jugular veins needed no division, but they were retracted laterally.
Incision of the deep fascia in the midline.
Retraction of the infrahyoid muscle and the fascial sheath laterally. 
Division of the pre-tracheal fascia covering the thyroid gland. 
Now the left lobe is retracted medially to expose the lateral surface of the lobe
 and the upper pole of the gland is delivered out to tie off the vascular pedicle comprising
 the superior thyroid vessels. The ties were applied very close to 
the gland to avoid possible injury to the external laryngeal nerve.
Ties to branches of inferior thyroid artery were applied; but all ties were plicated well
 away from the gland to prevent injury to the recurrent laryngeal nerve. 
The left lobe is then cut and followed to remove the isthmus also. 
Complete haemostasis is obtained by Fine ligatures, we avoided to use diathermy coagulation.
 The left lobe has a bit of retrosternal extension, 
and that required mobilization to free its intrathoracic extension.
Attention is now paid to the Right lobe of thyroid, repeating the same steps as in left lobe.
 Non-absorbable ties to the Superior thyroid vessels; followed by ties to branches of inferior thyroid vessels.
A haemostatic continuous absorbable suture in the isthmus to control haemorrhage, 
also with the Harmonic® scalpel.
Suction drainage is placed at the thyroid bed, and the tube was secured by silk suture. 
Closure of the deep fascia, and platysma using Vicryl sutures.
Suturing of the skin using 6/0  Ethilon.


----------



## cpc2007 (Sep 19, 2016)

The only code I see supported in the documentation is 60271 for a cervical approach with total thyroidectomy including a portion of the thyroid extending into the thoracic cavity behind the sternum.  I do not see any documentation of a limited neck dissection with a lymphadenectomy to support 60252.  I also do not see removal of parathyroid glands or reimplantation of any parathyroid glands as suggested in your original question.  Did you post the procedure description in its entirety?  If you did, I would report only 60271


----------



## Ravikirann (Sep 20, 2016)

Thanks for the reply.What i posted was the full OT notes.The doctor has mentioned Collar incision at a lower neck crease. Does it not enough to code limited neck dissection. The pathology report says the samples are adenocarcinmatous.


----------



## cpc2007 (Sep 20, 2016)

No, the collar incision would not qualify for reporting 60252 (the collar incision is just letting us know where the physician made that initial incision - at the base of the neck which means it was a cervical approach which is typical for a thyroidectomy).  In order to report CPT 60252 the physician has to identify and remove some enlarged lymph nodes (in my experience the most common documentation of this is a central lymphadenectomy).  The "limited neck dissection" being referenced in the code description for CPT 60252 is referring to the removal of those lymph nodes with the thyroid gland itself.  

A great resource I've found is a Coder's Desk Reference (CDR).  The book provides an expanded lay description of all surgical CPT codes so you can see the intent of the terms in the code descriptor.


----------



## Ravikirann (Sep 21, 2016)

Thank you for your inputs.I appreciate your effort.


----------

