Wiki thyroid lobectomy and total in same operative session

[freespririt0806]

so my question is:
lobectomy done path comes back malignant, in the same operative session the physician removes the entire thyroid

so am i to code 60260 for all remaining tissue
or total thyroidectomy 60240

thank you

 

[cpc2007]

Hi - this should be coded as 60240 for a total thyroidectomy when the removal of the entire thyroid gland occurs during a single surgery. The AMA has provided a couple of examples of when 60260 would be used in their CPT Assistant publication and have always focused on the fact that 60260 involves "re-entering a previous operating field with concern for dissection around nerves and parathyroids." Since they are not re-entering the operating field or dissecting around these structures again (they are still in the operating field) when removing the remaining thyroid tissue during the same session, 60260 would not be assigned.

I hope that helps

Kim
www.codingmastery.com

 

[jackjones62]

Hi there! Totally agree with Kim, the surgeon obviously suspected malignancy and most likely had a frozen section done to confirm while patient was still on the table, Total Thyroidectomy 60240 is correct.

 

[b.cobuzzi]

However, CPT instructs that if a biopsy is performed for an unknown outcome and then a full resection is performed based on frozen section, both the biopsy and the definitive resection can be coded (as long as we are not talking about skin. So, tiaralady, why was the lobectomy first performed. It looks like the lobectomy performed, sent for frozen section, came back malignant and then the whole thyroid was resected. So, you can either bill the lobectomy with an XU (or 59 modifier is the payer does not accept the X modifiers) and the total thyroidectomy. If the payer does not like that option you might want to consider a thyroid biopsy with the XU and the total thyroidectomy.