Otolaryngology Coding Alert

When your physician does a thyroidectomy as well as a lymph node dissection, you should take a second look at your claim -- you may have a single code that covers both procedures.

Avoid denials and save yourself precious time by taking this coding challenge. See if you have the skills necessary to submit these scenarios accurately.

When coding for thyroidectomy (60240-60271), keep a close eye on the code descriptors. "Many of them include all the procedures that the otolaryngologist performed, so you won't have to report additional codes for the auxiliary services," says Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.

Example 1: Your otolaryngologist removes both thyroid lobes with the isthmus and pyramid lobe tissue. He  also identifies and excises all enlarged lymph nodes. The malignancy has not spread significantly, so the otolaryngologist excises only a few selected lymph nodes. How would you report this?

Solution 1: You should report only 60252 (Thyroidectomy, total or subtotal for malignancy; with limited neck dissection), says Fariba Nesary, CPC, billing supervisor at University ENT in Albany, N.Y. This code includes reimbursement for the thyroidectomy and the limited dissection.

Example 2: During a total thyroidectomy, an otolaryngologist 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. How would you report this?

Solution 2: In this case, report only the thyroidectomy with radical neck dissection with 60254 (Thyroidectomy, total or subtotal for malignancy; with radical neck dissection), Nesary says. By definition, you shouldn't separately report the radical neck dissection (38720, Cervical lymphadenectomy [complete]).

CPT, however, throws you a curve ball when your physician combines thyroidectomy with modified radical neck dissection. None of the thyroidectomy codes specify this combination, which you'll have to code out separately.

Example 3: An otolaryngologist removes both thyroid lobes. But when removing a malignant lymphatic chain, she manages to preserve the spinal accessory nerve, jugular vein, and sternocleidomastoid muscles. How would you report this?

Solution 3: 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]). 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.

Although op report titles clue you in to how to code a procedure, otolaryngologists may use several monikers for a modified radical neck dissection.

Example 4: How would you report a functional neck dissection?

Solution 4: "Functional neck dissection is the same as a modified radical neck dissection," Nesary says. Another name your surgeon might use is "selective neck dissection." The code for these is 38724.

Instead of "neck dissections," CPT uses the terminology "lymphadenectomies," which fall under three codes:

• 38700 -- Suprahyoid lymphadenectomy

• 38720 -- Cervical lymphadenectomy (complete)

• 38724 -- Cervical lymphadenectomy (modified radical neck dissection).

Example 5: An otolaryngologist removes the lymph nodes as well as the sternocleidomastoid muscle, the spinal accessory nerve, and the internal jugular vein.

Solution 5: This is a radical neck dissection (38720). Note that you should report 38700 when the surgeon removes the nodes above the hyoid only.