Our physician performed a rt thyroid lobectomy and parathyroidectomy; codes he used are 60502 & 60220-59. I'm having a hard time figuring out if procedure 60220 would truly be separate. Any help would greatly be appreciated. His dictation reads;
The midline longitudinal raphe was divided with cautery and the strap muscles of the right neck elevated off the anterior lobe of the thyroid, adherent as expected from the patient's previous cervical fusion. The upper pole vessels were isolated and secured proximally with double 0 silk ties. The middle and the inferior pole vessels were individually taken off the capsular surface of the gland with interruped 3-0 silk and small surgical clips. The right inferior pole parathyroid gland was visualized, it was marked on it's anterior surface with a small surgical clip. The right thryoid lobe was dissected towards the midline where the thyroid isthmus was then divided at the confluence of the medical aspect of the left thyroid lobe with cautery and silk tie dissection. Once removed, that specimen was submitted for permanent pathologic exam.
The right recurrent laryngeal nerve was visualized and immediately posterior to that, lateral to the esophagus and within fibrosis from previous dissection was identified the upper pole parathyroid gland which upon further dissection was an obvious adenoma approx. 800 to 900mg in weight. It was circumferentially dissected from the surrounding soft tissue, its vascular pedicle isolated and secured with a small surgical clip. Both the right upper pole parathyroid adenoma and right thyroid lobe specimen were submitted together for pathologic exam.
The midline longitudinal raphe was divided with cautery and the strap muscles of the right neck elevated off the anterior lobe of the thyroid, adherent as expected from the patient's previous cervical fusion. The upper pole vessels were isolated and secured proximally with double 0 silk ties. The middle and the inferior pole vessels were individually taken off the capsular surface of the gland with interruped 3-0 silk and small surgical clips. The right inferior pole parathyroid gland was visualized, it was marked on it's anterior surface with a small surgical clip. The right thryoid lobe was dissected towards the midline where the thyroid isthmus was then divided at the confluence of the medical aspect of the left thyroid lobe with cautery and silk tie dissection. Once removed, that specimen was submitted for permanent pathologic exam.
The right recurrent laryngeal nerve was visualized and immediately posterior to that, lateral to the esophagus and within fibrosis from previous dissection was identified the upper pole parathyroid gland which upon further dissection was an obvious adenoma approx. 800 to 900mg in weight. It was circumferentially dissected from the surrounding soft tissue, its vascular pedicle isolated and secured with a small surgical clip. Both the right upper pole parathyroid adenoma and right thyroid lobe specimen were submitted together for pathologic exam.