Otolaryngology Coding Alert

You Be the Coder:

Post-Thyroid Removal, Thyroidectomy

Question: A patient who had a thyroidectomy seven years ago due to cancer returns for a revision thyroidectomy. The diagnosis is H-rthle cell carcinoma with metastatic involvement. Should I bill for another thyroid surgery with neck dissection?

Ohio Subscriber

Answer: When an otolaryngologist performs a thyroidectomy due to malignancy, she usually tries to save part of the thyroid and preserve the gland's function by performing a partial or subtotal lobectomy or thyroidectomy (60210-60225). Subsequently, however, she may have to remove the remaining tissue.

As in your example, if cancer is detected in the remaining thyroid tissue or nearby lymph nodes, the otolaryngologist may need to remove the remaining tissue. Report this procedure with 60260 (Thyroidectomy, removal of all remaining thyroid tissue following previous removal of a portion of thyroid). The ICD-9 diagnosis code for H-rthle cell is 193.