Otolaryngology Coding Alert

Question: A patient has hyperparathyroidism. The doctor explores the parathyroid and excises the left superior parathyroid adenoma. Should I bill 60500 for the parathyroid exploration and 60500 with modifier -59 for the excision of left superior parathyroid adenoma?

otolaryngology coding Alert Reader

Answer: No, you should not bill 60500 (Parathy-roidectomy or exploration of parathyroid[s]) for both procedures. The excision of the adenoma is a removal of a noncancerous tumor on the left superior parathyroid. These growths often cause hyperparathyroidism.

Your doctor probably performed the parathy-roidectomy to see if an adenoma existed. When she discovered the tumor, she removed the affected area. Report 60500 only.

Any partial or complete removal of any of the four parathyroid glands is included in 60500. Therefore, you would never assign 60500 for the same procedure twice.

Modifier -59 (Distinct procedural service) is used to identify procedures/services that are not normally reported together" but are appropriate under the circumstances " according to Appendix A in CPT 2002. Code 60500's definition states "parathyroidectomy or exploration." Therefore you would typically report the services together making modifier -59 inappropriate. Instances such as "a different site or organ system or separate incision/excision" justify using the modifier.

Consider an example offered by the May 2001 Bulletin of The American College of Surgeons. "A surgeon examines the neck for primary hyperparathy-roidism while exploring the parathyroids (60500) and encounters a thyroid nodule that is suspicious for malignancy. Due to the encounter of the unsuspected thyroid nodule a thyroid lobectomy and isthmusectomy is performed (60220)." Codes 60500 and 60220 are bundled. Therefore you would have to append modifier -59 to 60220 to indicate that the lobectomy and isthmu-sectomy occurred at a separate site.