General Surgery Coding Alert

Thyroidectomies and other related excisions, such as parathyroidectomies, can pose difficult coding challenges.
 
The thyroid is the largest of the endocrine glands, consisting of two lateral lobes connected by an isthmus. A third pyramidal lobe sometimes extends from the isthmus. The gland may become malignant or enlarged (goiter), which can result in partial or total removal. When malignancy is not involved, the surgeon may attempt to preserve thyroid function by saving portions of the gland.
 
Thyroid excision and related codes range from simple aspiration and biopsy to total thyroidectomy (when the entire thyroid is removed). The code list includes partial lobectomies, total lobectomies (sometimes referred to as a partial thyroidectomy) and subtotal" thyroidectomies and lobectomies :-- when most but not all of the lobe or complete thyroid has been removed. If part of the thyroid was removed for reasons unrelated to malignancy with some thyroid tissue saved to preserve function the surgeon may subsequently remove the remaining tissue. This service is reported by yet another code.
 
The surgeon may also remove a portion or all of the parathyroid glands (tissue adjacent to the thyroid that surgeons normally try not to disturb). When removal of a specific parathyroid gland or removal of most of the parathyroid tissue is performed for specific problems with these glands different codes -- some of which are bundled with some thyroid excision codes -- apply.
Biopsies Lobectomies and Other Partial Excisions 
Thyroid biopsies injections cyst excisions and partial excisions are described by seven codes:
 
60001 -- aspiration and/or injection thyroid cyst
 
60100 -- biopsy thyroid percutaneous core needle
 
60200 -- excision of cyst or adenoma of thyroid or transection of isthmus
 
60210 -- partial thyroid lobectomy unilateral; with or without isthmusectomy
 
60212 -- ... with contralateral subtotal lobectomy  including isthmusectomy
 
60220 -- total thyroid lobectomy unilateral; with or without isthmusectomy
 
60225 -- ... with contralateral subtotal lobectomy  including isthmusectomy. 
These procedures can be difficult to tell apart says Tray Dunaway MD FACS a general surgeon in private practice in Camden S.C. "People sometimes refer to total lobectomies where an entire lobe is removed as a total thyroidectomy " he says noting that many coders may not understand subtotal thyroidectomies or lobectomies or what makes them different from partial or total procedures.
 
When only a part of one thyroid lobe is excised (i.e. partial lobectomy) 60210 should be used. Sometimes part of one lobe and the greater portion of the other lobe may be removed simultaneously and 60212 should be reported. A "subtotal" lobectomy involves the excision of most of the thyroid lobe. Similarly a subtotal thyroidectomy involves removal of the greater portion of the entire thyroid gland.
 
Report 60220 when a complete lobe is removed. If a subtotal lobectomy (including isthmusectomy which involves the excision of the narrow connection between the two lobes of the thyroid gland) is also performed use 60225.
Total Thyroidectomies 
Total thyroidectomies performed [...]