Otolaryngology Coding Alert

Question: Following a right partial thyroid lobectomy, the pathology results came back indicating an invasive follicular thyroid carcinoma. The patient returned to the operating room (OR) one week following the partial thyroidectomy for a full thyroidectomy involving the remaining portions of the thyroid. How’s this to be coded?

Colorado Subscriber

Answer: In this example, you’re working with code 60210 (Partial thyroid lobectomy, unilateral; with or without isthmusectomy) for the initial surgery. Code 60210 has a global period of 90 days, meaning that you’ll code the follow-up surgery with the appropriate modifier to indicate that the surgery is a related procedure within the global period.

You will report code 60260 (Thyroidectomy, removal of all remaining thyroid tissue following previous removal of a portion of thyroid) to identify the surgery to remove the entirety of the remaining thyroid. Also, you will append modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period) to 60260.

Furthermore, you should understand why this scenario does not qualify for the use of modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period). While on the surface this surgical encounter might check some of the respective boxes of modifier 78 (unplanned, related procedure), you’ve got to take into account that the surgeon is not treating a complication. Rather, the patient has graduated from conservative surgical care to a more radical therapeutic approach.

This kind of scenario, in which a more comprehensive surgery is required following a less invasive approach, meets all the criteria for modifier 58. Specifically, the CPT^® manual explains that you should report modifier 58 when a procedure in the postoperative period was “more extensive than the original procedure.” The CPT^® manual further elaborates that modifier 78 involves a return to the operating room (OR) for an “unanticipated clinical condition.” In a surgical scenario such as this, the surgeon anticipates that the initial therapeutic approach may not be enough, leaving the open-ended possibility of a return to the OR at a later date.