# thyroid/parathyroid



## darlene1 (Dec 7, 2015)

I know that the parathyroidectomy and thyroidectomy are incidental to each other but as they are two different procedures would it be acceptable to amend modifier 22 to the parathyroid?
can anyone help me know if there is any way to bill these two surgeries on same patient same day of service?


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## catprocode (Apr 11, 2016)

*60240 vs 60500*

You should be billing cpt 60220 not 60500 (even though this one has more RVU's) 
A modifier 22 would not be appropriate if appending to 60240 for the removal of the parathyroid glands 
However, if the physician was performing the 60500 then seen a lesion on the thyroid gland this would be (incidental) then a 59 mod would be appropriate on cpt 60500. 
I have rarely seen enough documentation in the op note to bill for this and if there is 9 times out of 10 insurance companies are going to deny one of them. 

Here is the article from supercoder 

Question: During a parathyroidectomy for a malignant tumor, the otolaryngologist encounters a thyroid nodule that is suspicious for malignancy. Based on finding the unsuspected thyroid nodule, she performs a thyroid lobectomy with isthmusectomy. Should I report both the parathyroidectomy (60500) and the lobectomy (60220)?

Oklahoma Subscriber

Answer: Even though the National Correct Coding Initiative bundles parathyroidectomy (60500, Parathyroidectomy or exploration of parathyroid) into thyroid lobectomy (60220, Total thyroid lobectomy, unilateral; with or without isthmusectomy), in this case you should report both the parathyroidectomy and the resulting thyroid excision procedure. The NCCI edits contain a "1" modifier indicator, which means you may use modifier -59 (Distinct procedural service) to override the bundle. To bill 60500-59, documentation must support billing the parathyroidectomy as a distinct procedure from the thyroid lobectomy.

Because the otolaryngologist, while performing a parathyroidectomy for a malignant tumor (194.1, Malignant neoplasm of parathyroid gland), finds a lesion on the thyroid gland (193, Malignant neoplasm of thyroid gland) that requires biopsy and/or excision, the thyroid lobectomy doesn't include the parathyroidectomy. Therefore, you should report 60220 and 60500-59.

But if, during a thyroidectomy, the otolaryngologist removes the parathyroids due to their close proximity to the thyroid, you shouldn't report the parathyroidectomy (60500). In these cases, the parathyroids' removal is incidental to the thyroid excision and is not separately payable.

To avoid denials for separately reportable 60500-59 claims, encourage your otolaryngologist to include documentation that shows the parathyroidectomy's distinct nature. For instance, a note in a "Findings" section stating that during the parathyroidectomy the otolaryngologist observed a lesion on the thyroid, which resulted in the decision to perform the thyroid excision, will help substantiate 60500 as a distinct procedure. You  may also want to include a statement that the otolaryngologist didn't intend to perform a thyroidectomy until she performed the parathyroidectomy.


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## amexnikki23 (Oct 16, 2017)

*The CCI edit (MUO) is on the 60220, and not the 60500 though, can you reassess? thx*

Hi, the below answer is stating to add the modifier to 60500 however, the CCI edit is attached to 60220 per Encoder. So, if the patient had both a lesion on the thyroid AND the parathyroid, the modifier would go onto the 60220, correct? 



catprocode said:


> You should be billing cpt 60220 not 60500 (even though this one has more RVU's)
> A modifier 22 would not be appropriate if appending to 60240 for the removal of the parathyroid glands
> However, if the physician was performing the 60500 then seen a lesion on the thyroid gland this would be (incidental) then a 59 mod would be appropriate on cpt 60500.
> I have rarely seen enough documentation in the op note to bill for this and if there is 9 times out of 10 insurance companies are going to deny one of them.
> ...


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