# Total vs Partial Thyroid Lobectomy, Unilateral; with or without isthmusectomy



## slwitt

Our General Surgeons perform Thyroidectomies, mainly unilateral. They state they are always totals however, on a few of their notes they have stated that they remove 95% or had to leave some of the lobe behind due to the nerve or 10 to 15% behind. They requested I find out if it was 100% had to be removed or if a small percentage remained it could still be coded as Total. One physician stated he believed if 80% was removed it could still be coded as total. Has anyone heard of this?


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## jackjones62

Yes, residual thyroid tissue is often left after performing a "total thyroid lobectomy"  - one lobe, or "total thyroidectomy", both lobes.  You are billing correctly with regards to a "total thyroid lobectomy" (unilateral) CPT 60220, regardless that some thyroid tissue remains.  Any questions, do not hesitate.

Jennifer
CT ENT


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## slwitt

Do you possibly have a reference for this? I have received a response from a consultant I use that states it would not be a total. I search the CPT Assistant and tried an ENT newsletter without success. The consultant is just repeating the CPT Annotations to me. I appreciate any supporting documentation you have for this.


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## KBean2018

*Need help as well! Partial or Total?*

Hello, can I code as partial or total? Also I don't see that the parathyroid autotransplant can be coded as well for 60210 and 60220. Need help with info for that as well. Thanks in advance!

CPT Code: Procedure:    RIGHT THYROID LOBECTOMY
CPT(R) Code:  PR THYROID LOBECTOMY,UNILAT
*
Procedure:    PARATHYROID AUTOTRANSPLANT

Description of Procedure: In the supine position with appropriate monitoring she received general endotracheal anesthesia with IV antibiotic.  Shoulder roll was placed.  The neck is gently extended, the neck and chest widely prepped with chlorhexidine and draped after 3 minutes.  A standard Coller incision made, deepened through skin and adipose tissue with cautery dividing platysma, upper and lower flaps are created.  The midline raphae is displaced to the left, identified and opened.  The thinned sternohyoid muscle retracted laterally, the SCM muscle is also exposed, somewhat thinned by the mass.  We elevate and separate the flimsy attachments with direct vision using Harmonic Focus.  The upper pole is released quite high, dividing directly on the gland with Harmonic Focus.  The upper pole is retracted medially and elevated, separating soft tissue with a Kitner dissector.  I now recognized the right superior parathyroid gland, and submitted for frozen section.  The remainder is minced into 1 mm cubes placed in a saline gauze.  When frozen section returns confirmatory, we cease operation, make to avascular pockets in the anterior SCM and placed 4 and 5 cubes into each of the pockets, covered with horizontal 4–0 polypropylene suture.  Return to the thyroid with elevation the course of the recurrent nodule nerve is identified, a very prominent tortuous artery is inadvertently cut and secured with a clip, this is slightly caudal to the identified and protected recurrent laryngeal nerve.  Just to the right and inferior of this artery is the right inferior parathyroid gland marked with a suture.  With the nerve and parathyroid recognized, we used the Harmonic Focus to separate and divide tissues off the ligament of Berry, off the anterior trachea, taking the inferior pole directly on the gland including the vessels.  The isthmus is released at its junction with the otherwise normal left side and divided with Harmonic Focus.  The oriented specimen is submitted.  We have irrigated with saline with clear return.  Blood loss from the arterial disruption and during dissection of the large mass was about 20 mL.  We placed Fibrillar sheets to minimize blood accumulation and place a 10 French channel drain to exit inferolaterally held with silk.  We inspected for any active bleeding and none found and now reapproximate the midline with running lock 4-0 Vicryl suture.  Platysma was closed with simple running 4-0 suture, skin with running subcuticular technique.  Dermal glue and dressing are applied.  She is awakened and extubated in the operating suite, transported to PACU.


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## daniel

Did you review 

2012DecemberCPT® Assistant

If you like me to pass it along. Let me know. as for Add-on code 60512 may not be reported in addition to the primary procedure, in the event the transplant site is in the neck (eg, sternocleidomastoid muscle) and approached through the same neck incision as the primary procedure into adjacent tissue.


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