Otolaryngology Coding Alert

Question: Can someone help me explain to my physician why CPT^® code 60500 bundles into 60240? He is questioning it because the parathyroid exploration and excision was indicated for a clinical indication distinct from the indication related to thyroidectomy (parathyroid adenoma and hyperparathyroidism for 60500 and multinodular goiter for 60240).

South Carolina Subscriber

Answer: The descriptors themselves are self-explanatory. CPT^® code 60240 (Thyroidectomy, total or complete) describes a total or complete thyroidectomy; code 60500 (Parathyroidectomy or exploration of parathyroid[s]) describes a parathyroidectomy or exploration of parathyroid(s). Exploring the parathyroid glands (with or without parathyroidectomy) is standard surgical practice when performing a complete thyroidectomy. Therefore, code 60500 is bundled into code 60240. 

However: Keep in mind that if your physician performs an autotransplantation of the parathyroid (60512, Parathyroid autotransplantation [List separately in addition to code for primary procedure]), this service is not bundled with a thyroidectomy. Some payers have been known to deny 60512 when performed with a thyroidectomy because they have an edit that expects one of the parathyroid codes to be included with 60512. Even though the surgeon performs a parathyroidectomy, it cannot be coded, so the parathyroid codes are not on the claim because of the edits in place for 60512. This needs to be explained to the payer when you appeal their denial so they’ll understand why your surgeon should be paid for both procedures.