Wiki Cpt 60210

[debnance2@icloud.com]

Partial thyroid lobectomy, unilateral; with or without isthmusectomy

My physician did partial lobectomy on both the right and the left. As the CPT book doesn't say "unilateral or bilateral" I understood that we could bill both sides. The insurance company says no. What am I missing?

 

[nrichard]

Code description

If you look in CPT the descriptor to this code says that 60210 is unilateral.

 

[mitchellde]

Partial thyroid lobectomy, unilateral; with or without isthmusectomy

My physician did partial lobectomy on both the right and the left. As the CPT book doesn't say "unilateral or bilateral" I understood that we could bill both sides. The insurance company says no. What am I missing?

Did the payer say no because you used the 50 modifier? Or because you used two lines one with LT one with RT? Or because they reject the dx code? What did the payer state as the reason for the denial?

 

[debnance2@icloud.com]

The payer stated that "unilateral" means that regardless of whether the procedure was right, left or both lobes because he worked within the same incision it is only payable once.

 

[mitchellde]

Ummm.. No that is wrong interpretation. Unilateral mean the procedure is intended to apply only to one side as opposed to both. To settle this you need a coders desk reference for procedures. This is the best book ever for CPT help. It will give you in lay person language the definition of the procedure in terms of what is performed. I highly suggest it and then use that books definition as your authoritative source for an appeal. I have always been successful with this strategy. You can obtain this book via the Internet or sometimes they have it on the shelf at the book store.