MChase928
Contributor
Hello, ENT coders. Please read through the following op note and comment re my coding questions below. Thank you for your input.
Background: patient had LT hemithyroidectomy approx 20 years ago by another surgeon, benign.
Pre-op diagnosis: substernal thyroid with tracheal compression. Post-op diagnosis: same.
Operation: Removal of substernal thyroid mass, did not remove residual right thyroid lobe.
Procedure note: After general anesthesia induction and intubation with a laryngeal monitoring tube that was checked and verified, the neck was prepped and draped. Low neck transverse incision was made and midline dissection performed down to the substernal mass. Using the Harmonic scalpel hemoclips, and bipolar and regular cautery dissection of the mass was performed with blunt dissection. The mass was finger and kitner dissected out and removed from the substernal space. This released the pressure on the trachea. After removal all bleeding was controlled and surgicel was placed in the wound. The right lobe of the thyroid was preserved and looked normal in appearance and size. Parathyroid on the right was identified and recurrent laryngeal nerves protected. Closure was performed with 4-0 and 5-0 monocryl suture and dermabond and steristrips applied to the skin over a suction drain. Procedure was terminated and patient was awakened and taken to pace in stable condition.
Pathology returned multinodular hyperplasia (goiter) with focal adenomatoid nodule, negative for malignancy.
Questions: Coded 60200 excision of cyst or adenoma of thyroid for surgeon's review. The surgeon wants this coded as 60220 total thyroid lobectomy, unilateral, with or without isthmusectomy, which doesn't seem appropriate as LT lobe was previously removed and RT lobe wasn't removed in this procedure. Is 60271-52 appropriate as substernal throid is indicated in the description though neither LT nor RT lobes were removed? Is there a more appropriate code I've overlooked? Thank you for your help.
Background: patient had LT hemithyroidectomy approx 20 years ago by another surgeon, benign.
Pre-op diagnosis: substernal thyroid with tracheal compression. Post-op diagnosis: same.
Operation: Removal of substernal thyroid mass, did not remove residual right thyroid lobe.
Procedure note: After general anesthesia induction and intubation with a laryngeal monitoring tube that was checked and verified, the neck was prepped and draped. Low neck transverse incision was made and midline dissection performed down to the substernal mass. Using the Harmonic scalpel hemoclips, and bipolar and regular cautery dissection of the mass was performed with blunt dissection. The mass was finger and kitner dissected out and removed from the substernal space. This released the pressure on the trachea. After removal all bleeding was controlled and surgicel was placed in the wound. The right lobe of the thyroid was preserved and looked normal in appearance and size. Parathyroid on the right was identified and recurrent laryngeal nerves protected. Closure was performed with 4-0 and 5-0 monocryl suture and dermabond and steristrips applied to the skin over a suction drain. Procedure was terminated and patient was awakened and taken to pace in stable condition.
Pathology returned multinodular hyperplasia (goiter) with focal adenomatoid nodule, negative for malignancy.
Questions: Coded 60200 excision of cyst or adenoma of thyroid for surgeon's review. The surgeon wants this coded as 60220 total thyroid lobectomy, unilateral, with or without isthmusectomy, which doesn't seem appropriate as LT lobe was previously removed and RT lobe wasn't removed in this procedure. Is 60271-52 appropriate as substernal throid is indicated in the description though neither LT nor RT lobes were removed? Is there a more appropriate code I've overlooked? Thank you for your help.