Wiki Medicare denied 2nd thyroidectomy

[jackjones62]

CT Medicare (administered by National Goverment Services - Indianapolis) has denied a
2nd thyroidectomy - CPT 60220, indicating that it is only billable "one per lifetime"; our patient had a right thyroidectomy (CPT 60220); when final pathology came back papillary carcinoma, the patient was brought back into the OR within 2 weeks for the left thyroid lobe to be removed; CPT 60220 was billed again w/modifier 58 & 22; but, in view of the denial, it would not matter what modifier was used.

I am so angry I could spit, CPT defines 60220 as unilateral, has anyone else run into this problem with Medicare????

Jennifer
CT ENT

 

[meo59101]

Modifier -78 might be more appropriate than -58.

 

[gmfracasso]

Medicare denial

I agree modifie 58 is appropriate here. Unfortunately, 60220 does have an MUE of '1'. This is not consistnat with the coding options for Thyroidectomy. You should appeal and go all the way to ALJ, if necessary.