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Inpatient Facility Coding & Compliance Alert

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Tackle Neck Dissection Codes the Right Way

Published on Mon Jun 16, 2014

Question: The neck dissections are surgically classified into radical neck dissection, modified radical neck dissection and selective neck dissection. Does limited neck dissection relate to modified neck dissections where some of the vital structures can be saved? Can 60252 be therefore used for modified neck dissections? Please correct me if I am wrong.

Massachusetts Subscriber

Answer: Keep a close eye on the code descriptors when coding for thyroidectomy procedures, such as neck dissections. Consider the examples below. 
  • If a provider excises only a few selected lymph nodes with a thyroidectomy, he performs a thyroidectomy with limited neck dissection. You should report only 60252 (Thyroidectomy, total or subtotal for malignancy; with limited neck dissection). 
  • If the physician states in the operative note that she performed thyroidectomy with a "central neck dissection,” this too represents a limited neck dissection, not a radical or modified radical neck dissection. You can report 60252.
  • If in another case, the provider dissects all the levels of lymph nodes and must sacrifice the spinal accessory nerve, jugular vein and sternocleidomastoid muscles to remove a malignant lymphatic chain, this would qualify for 60254 (Thyroidectomy, total or subtotal for malignancy; with radical neck dissection). You shouldn’t separately report the radical neck dissection (38720, Cervical lymphadenectomy [complete]) since 38720 and 60254 are bundled together. The procedure of radical neck dissection is included in 60254.
  • Suppose the provider removes both thyroid lobes. But when removing a malignant lymphatic chain, she manages to preserve the spinal accessory nerve, jugular vein, and sternocleidomastoid muscles. This is thyroidectomy with modified radical neck dissection. 
In a modified radical neck dissection, the surgeon dissects all levels of the lymph nodes on one side of the neck but spares the sternocleidomastoid muscle, the spinal accessory nerve, and the jugular vein. Because CPT® doesn’t include a code for the thyroidectomy with modified radical neck dissection, you should report 60240(Thyroidectomy, total or complete) with 38724 (Cervical lymphadenectomy [modified radical neck dissection]). You may add modifier 59 (Distinct procedural service) if you have documentation supporting that the thyroidectomy and lymphadenectomy were separate procedures. 

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