Otolaryngology Coding Alert

Tipper Gore, wife of Vice President Al Gore, recently underwent surgery to remove a nodule on her thyroid gland. The nodule was then examined by pathologists to determine if it was cancerous.

In this instance, the procedure, a right thyroid lobectomy (60220, total thyroid lobectomy, unilateral; with or without isthmusectomy), was performed by a general surgeon at Johns Hopkins Medical Center in Baltimore and took just over two hours. This procedure often is performed by an otolaryngologist, says Lee Eisenberg, MD, an otolaryngologist in Englewood, N.J., and a member of the American Medical Associations CPT editorial panel and executive committee.

Based on the news reports, Mrs. Gores diagnosis likely was a thyroid nodule (241.0, nontoxic uninodular goiter; thyroid nodule), Eisenberg says. Another possibility is 226 (benign neoplasm of thyroid glands).

Earlier diagnostic studies, which included fine needle aspiration (FNA) (88170, fine needle aspiration with or without preparation of smears; superficial tissue [e.g., thyroid, breast, prostate]) and likely also an ultrasound (76536, echography, soft tissues of head and neck [e.g., thyroid, parathyroid, parotid], B-scan and/or real time with image documentation) were inconclusive.

According to news reports, physicians discovered the growth on Mrs. Gores thyroid while treating her for chronic neck pain stemming from what the second ladys spokeswoman called an exercise-related injury.

When FNA results are inconclusive or suspicious, a precautionary removal of all or part of the thyroidsuch as the lobectomy performed on Mrs. Goreare recommended.

Analysis of the growth and testing for thyroid cancer is estimated to take about a week. If the growth is cancerous, depending the type of thyroid cancer and whether the cancer has spread outside the thyroid area, the next step likely would be full removal of the thyroid (60260), followed by a course of radioactive iodine therapy.