# Excision Isthmus



## msmileyb (Oct 7, 2008)

I have a couple of questions regarding these scrubbed op notes.


Op Notes

Skin incision, and dissection was carried down through the strap muscles and onto the thyroid isthmus, which was divided with electrocautery. An incision was made in the trachea btwn the 2nd & 3rd tracheal rings, and the tracheal dilator was used to dilate this opening. The endothracheal tube was withdrawn and a #8 tracheostomy tube was placed atraumatically and postion confirmed with a return of CO2 and oxygen saturation of 100%. A suction catheter was passed for aspiration of tracheal content. the tracheostomy tube was then secured with 2-0 silk sutures and a trach tie. The cardiothoracic and plastic teams then proceeded with the remainder of the procedure.

I have a couple of questions regarding these scrubbed op notes.

1. Is the dissection/transection of the thyroid isthmus separately reportable by using cpt 60200 or is it incidental to the tracheostomy. The lay description in ingenix states "the thyroid isthmus is cut if necessary"

2. CPT 60200 is under the excision portion of the section. Does this mean that the code should read excision of cyst or excision adenoma of the thyroid or excision transection of isthmus. Is it me or is there something wrong with the wording?

3. What do you do when a doctor says they don't want the lay description from ingenix, the CPT book does not state what the ingenix lay description says? Does AMA provide lay descriptions that i can refer to?


CPT 31600 - *Tracheostomy, planned (separate procedure); *
Lay description (ingenix) - The physician creates a tracheostomy. The physician makes a horizontal neck incision and dissects the muscles to expose the trachea. The thyroid isthmus is cut if necessary. The trachea is incised and an airway is inserted. After bleeding is controlled, a stoma is created by suturing the skin to the tissue layers.

CPT 60200 - *Excision of cyst or adenoma of thyroid, or transection of isthmus*
Lay description (ingenix) - The physician removes a cyst or adenoma from a thyroid, or transects the isthmus. The physician exposes the thyroid via a transverse cervical incision in the skin line. The platysmas is divided and the strap muscles separated in the midline. The thyroid mass is identified. Blood supply to and from the lesion is controlled and the mass is locally excised. The skin and platysmas are closed.  

Thanks for chimming in and sharing your thoughts


----------



## eblanken (Oct 7, 2008)

It sounds like all your physician did was perform the tracheostomy. 60200's description according to Decision Health is: (Plain English Description™) The physician removes a cyst or a blood-filled growth from the thyroid gland, or cuts the tissue that connects the right and left side of the thyroid gland in the front of the throat. From what your physician described he performed the tracheostomy that is described in 31605. Since you did not state whether this was an emergent procedure it seems your only option to be 31600. Hope this helps.


----------

