2.Disease and Condition​​

1.     Thyroid Cancer

2.     Thyroid Nodule

3.     Hyperthyroidism: Overactive Thyroid

4.     Goitre: Enlargement of Thyroid gland

5.     Thyroiditis: Inflammation of Thyroid

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3.Surgical treatment

Thyroidectomy : A thyroidectomy is a surgical procedure in which all or part of the thyroid gland is removed.

Total Thyroidectomy : Complete removal of thyroid gland.

Lobectomy: A thyroid lobectomy is a surgical procedure where one of the two lobes of the thyroid gland is removed.

4.How to lead correct CPT Code

​In CPT book ,

Excision-Thyroid Gland- Adenoma or Cyst- 60200

Excision-Thyroid Gland- - Lobectomy-Partial- 60210, 60212

Excision-Thyroid Gland- Lobectomy-Total- 60220, 60225

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Thyroid Gland-Excision(Thyroidectomy)- Adenoma Cyst- 60200

Thyroid Gland-Excision(Thyroidectomy)- Lobecectomy- 60210,60212,60220,60225

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Thyroid Gland-Excision(Thyroidectomy)- Malignancy, Total or Subtotal-Limited Neck Dissection- 60252

Thyroid Gland-Excision(Thyroidectomy)- Malignancy, Total or Subtotal-Limited Neck Dissection- 60254

Thyroid Gland-Excision(Thyroidectomy)- Secondary- 60260

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Thyroid Gland-Excision(Thyroidectomy)- Total (Complete)- 60240

Thyroid Gland-Excision(Thyroidectomy)- Total (Complete)-Cervical- 60271

Thyroid Gland-Excision(Thyroidectomy)- Total (Complete)-Sternal/ Transthoracic- 60270

Thyroid Gland-Excision(Thyroidectomy)- Total (Complete)-Transcervical- 60520

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5.Code selection criteria for Thyroidectomy

The code selection criteria for Thyroidectomy

​1.Portion of thyroid removed- Lobectomy, Subtotal Thyroidectomy, Total Thyroidectomy

2.Malignancy with Lymph node dissection

3.Approach for Total Thyroidectomy

Tips 1​​

60200: ( Cyst/ Adenoma Removal ) The provider removes a cyst or a blood–filled growth from the thyroid gland, or incises the tissue that connects the right and left side of the thyroid gland in the front of the throat.

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60210: ( Partial Thyroid Lobectomy w/0 - ishmus )This is a procedure involving surgical removal of a part of one of the two lobes the thyroid gland is divided into. The provider may perform the procedure with or without surgical removal of the isthmus, the tissue connecting the two lobes of the thyroid gland in the middle.

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60212: The procedure involves surgical removal of a part of one lobe of the thyroid gland and most of the portion of the other lobe of the thyroid gland. The provider also performs surgical removal of the isthmus, the tissue connecting the two lobes of the thyroid gland in the middle.

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60220: (Total Thyroidectomy Lobectomy ) This is a procedure involving complete surgical removal of one of the two lobes the thyroid gland is divided into. The provider may perform the procedure with or without surgical removal of the isthmus, the tissue connecting the two lobes of the thyroid gland in the middle.

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60225: (Total Thyroidectomy Lobectomy ) The procedure involves surgical removal of one whole lobe of the thyroid gland and most of the other lobe of the thyroid gland. The provider also performs surgical removal of the isthmus, the tissue connecting the two lobes of the thyroid gland in the middle.

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60240: (Total Thyroidectomy) The procedure involves surgical removal of the entire thyroid gland.

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60252: ( Thyroidecomy for malignancy) The procedure involves surgical removal of the entire thyroid or most of the thyroid, including the isthmus. The provider also performs limited lymph node dissection of the neck.

You may use 60252 for thyroidectomy with removal of nonmalignant lymph nodes as well as for malignant lymph node removal. The code describes malignancy for the thyroid and not for the lymph nodes per note.

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60254:( Thyroidecomy for malignancy) The procedure involves surgical removal of the entire thyroid or most of the thyroid, including the isthmus. The provider also performs neck dissection to remove neck structures extensively including malignant lymph nodes of the neck.

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60260:( Secondary Thyroidecomy ) The procedure involves surgical removal of the entire remaining thyroid tissue left from a previous thyroid operation, such as lobectomy. The provider typically performs this when there is evidence of cancer in the existing lobe of the thyroid. The procedure is also known as completion thyroidectomy.

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60270: (Substernal Thyroid- Sternal split or Transthoracic Approach)The provider removes the thyroid gland including the extension of the gland below the breastbone. The procedure is required for more complex benign conditions, such as a very large goiter, cyst, or benign or malignant conditions that extend into the upper chest.

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60271: (Substernal Thyroid- Cervical Approach)The procedure involves surgical removal of the thyroid gland including its extension into the thorax below the sternum.

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+60512 :Parathyroid autotransplantation (List separately in addition to code for primary procedure).

Providers perform this procedure along with a primary procedure of thyroidectomy or parathyroidectomy. In this procedure, the provider takes the excised parathyroid tissue and places it into a muscle pocket either in the side of the neck or in the forearm muscles. The tissue develops a blood supply and starts working in 4 to 6 weeks.​​

Live Sample Chart 1

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OPERATION: Total thyroidectomy for goiter.

INDICATION FOR SURGERY: This is a 41-year-old woman who notes that compressive thyroid goiter and symptoms related to such who wishes to undergo surgery. Risks, benefits, alternatives of the procedures were discussed in great detail with the patient. Risks include but were not limited to anesthesia, bleeding, infection, injury to nerve, vocal fold paralysis, hoarseness, low calcium, need for calcium supplementation, tumor recurrence, need for additional treatment, need for thyroid medication, cosmetic deformity, and other. The patient understood all these issues and they wished to proceed.

PROCEDURE DETAIL: After identifying the patient, the patient was placed supine in a operating room table. After establishing general anesthesia via oral endotracheal intubation with a 6 Nerve Integrity monitoring system endotracheal tube. The eyes were then tacked with Tegaderm. The Nerve Integrity monitoring system, endotracheal tube was confirmed to be working adequately.

 

Essentially a 7 cm incision was employed in the lower skin crease of the neck. A 1% lidocaine with 1:100,000 epinephrine were given. Shoulder roll was applied. The patient prepped and draped in a sterile fashion. A 15-blade was used to make the incision. Subplatysmal flaps were raised to the thyroid notch and sternal respectively. The strap muscles were separated in the midline. As we then turned to the left side where the sternohyoid muscle was separated from the sternothyroid muscle there was a very dense and firm thyroid mass on the left side. The sternothyroid muscle was transected horizontally. Similar procedure was performed on the right side.

Attention was then turned to identify the trachea in the midline. Veins in this area and the pretracheal region were ligated with a harmonic scalpel. Subsequently, attention was turned to dissecting the capsule off of the left thyroid lobe. Again this was very firm in nature. The superior thyroid pole was dissected in the superior third artery, vein, and the individual vessels were ligated with a harmonic scalpel. The inferior and superior parathyroid glands were protected. Recurrent laryngeal nerve was identified in the tracheoesophageal groove. This had arborized early as a course underneath the inferior thyroid artery to a very small tiny anterior motor branch. This was followed superiorly. The level of cricothyroid membrane upon complete visualization of the entire nerve, Berry's ligament was transected and the nerve protected and then the thyroid gland was dissected over the trachea. A prominent pyramidal level was also appreciated and dissected as well.

Attention was then turned to the right side. There was significant amount of thyroid tissue that was very firm. Multiple nodules were appreciated. In a similar fashion, the capsule was dissected. The superior and inferior parathyroid glands protected and preserved. The superior thyroid artery and vein were individually ligated with the harmonic scalpel and the inferior thyroid artery was then ligated close to the thyroid gland capsule. Once the recurrent laryngeal nerve was identified again on this side, the nerve had arborized early prior to the coursing underneath the inferior thyroid artery. The anterior motor branch was then very fine, almost filamentous and stimulated at 0.5 milliamps, completely dissected toward the cricothyroid membrane with complete visualization. A small amount of tissue was left at the Berry's ligament as the remainder of thyroid level was dissected over the trachea. The entire thyroid specimen was then removed, marked with a stitch upon the superior pole. The wound was copiously irrigated, Valsalva maneuver was given, bleeding points controlled. The parathyroid glands appeared to be viable. Both the anterior motor branches that were tiny were stimulated at 5 milliamps and confirmed to be working with the Nerve Integrity monitoring system.

Attention was then turned to burying the Surgicel on the wound bed on both sides. The strap muscles were reapproximated in the midline using a 3-0 Vicryl suture of the sternothyroid horizontal transection and the strap muscles in the midline were then reapproximated. The 1/8th inch Hemovac drain was placed and secured with a 3-0 nylon. The incision was then closed with interrupted 3-0 Vicryl and Indermil for the skin. The patient has a history of keloid formation and approximately 1 cubic centimeter of 40 mg per cubic centimeter Kenalog was injected into the incisional line using a tuberculin syringe and 25-gauge needle. The patient tolerated the procedure well, was extubated in the operating room table, and sent to postanesthesia care unit in a good condition. Upon completion of the case, fiberoptic laryngoscopy revealed intact bilateral true vocal fold mobility.

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