Otolaryngology Coding Alert

Question: My insurance company always bundles 60500 into 60240. If the physician performs a parathyroidectomy for a parathyroid adenoma and a complete thyroidectomy for a multinodular goiter, should we expect to get both paid? If so, should we be applying a modifier?

Connecticut Subscriber

Answer: Ultimately, the answer to this question comes down to the operative note. The exploration of the parathyroid is generally seen as an included component of a complete thyroidectomy. The National Correct Coding Initiative (NCCI) edits reaffirm this, as 60500 (Parathyroidectomy or exploration of parathyroid[s]) is automatically bundled into 60240 (Thyroidectomy, total or complete).

However, included in the CCI edits is an option to apply modifier 59 (Distinct Procedural Service) or modifier XU (Unusual Non-Overlapping Service), depending on whether or not it’s a Medicare claim. The use of either of these modifiers is only justifiable if the operative notes back up the claim that these two procedures are, in fact, separate from one another. The documentation must clearly state that the surgeon removed the parathyroid gland and the thyroid gland for totally separate diagnostic reasons.

When is modifier 59 not justified? Sometimes, a surgeon might remove part of the parathyroid gland during the process of performing a thyroidectomy. In this case, the removal of the parathyroid is considered incidental to the complete thyroidectomy, so, you would only bill for code 60240. Keep in mind that 60500 includes either an exploration of the parathyroid(s) or the resection of the parathyroid gland. When a thyroidectomy is performed and the surgeon has also explored the parathyroid(s) without removing them, only code 60240.