# Help! 60210 or 60220



## lcathey@smsc.org (Oct 28, 2013)

Please code this note .  I think it is 60220, but the hospital is using 60210.  Thanks!!!

PREOPERATIVE DIAGNOSIS:

Right thyroid mass.




POSTOPERATIVE DIAGNOSIS:

Follicular adenoma, right thyroid.




PROCEDURE PERFORMED:

Right thyroid lobectomy




SURGEON:

Charles Richard Frazier, MD




ANESTHESIA:

General.










FINDINGS:

The right thyroid lobe was basically occupied with a 4-5 cm, well

circumscribed, welling encapsulated, slightly inflamed neoplasm

that on fine-needle aspiration had suggested a follicular lesion

with Hurthle cell features.  There was no associated adenopathy

in the neck on the right, and there was no evidence of

abnormality of significant abnormality on the left.




SUMMARY:

After induction of adequate general endotracheal anesthesia, the

patient received a vertical intrascapular roll and the neck was

fully extended.  The anterior neck and chest were then prepped

and draped in the sterile fashion.  A standard collar type

incision was made transversely between the sternocleidomastoid

muscles and carried down sharply through the platysma.  Platysmal

flaps were raised superiorly to the level of the cricothyroid

membrane and inferiorly to the sternal notch.  The strap muscles

were opened in the midline.  The strap muscles were then

carefully dissected off of the right thyroid mass.  Carefully the

middle thyroid vein was identified and ligated over 4-0 silk and

then the inferior pole vessels were dealt with in the same way.

It was at this point, with the medial rotation now possible that

the inferior parathyroid on the right was identified and

protected.  Carefully the recurrent laryngeal nerve was

identified and during this portion of the dissection the superior

parathyroid was identified and protected.  The superior pole

vessels were then divided over 3-0 silk and the gland rotated

medially.  Carefully the nodule and the lobe were dissected off

the tracheoesophageal groove protecting the nerve throughout its

course, allowing division of the ligament of Berry, bringing the

lobe and nodule up to the isthmus.  The isthmus was then crushed,

clamped and the mass sharply removed.  The isthmus was ligated

over running locking 2-0 silk.  Immediate pathologic evaluation

suggested a follicular neoplasm, but no evidence of malignant

change was seen and once again, some Hurthle cell features were

noted.  Therefore, attention was turned toward closure.  In this

regard, the neck was irrigated and hemostasis confirmed with

Avitene.  The strap muscles and platysma were closed with

interrupted 3-0 chromic while the skin was closed with running 4-

0 Vicryl in an intracuticular fashion.  Steri-Strips and sterile

dressings were applied.  Final needle lap sponge and instrument

counts were reported as correct.  At extubation the vocal cords

were directly visualized and both were equally mobile.  She was

taken to recovery in stable condition.


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