As seen in the picture below, the thyroid gland, which is part of the endocrine system, is found in the neck. It is a butterfly-shaped gland that has the primary purpose of secreting hormones that control the body’s metabolism. Each side of the thyroid is called a lobe and the area or bridge of thyroid tissue that connects the lobes is called the isthmus. Additionally, four, small, pea-sized glands called the parathyroid glands are situated behind the thyroid glands. Their function is to produce a hormone that controls the calcium level in the body.
A variety of different conditions could lead to a procedure being performed on the thyroid. Those conditions include development of a cyst, goiter, nodule, or tumor. A goiter is simply enlargement of the thyroid gland. A needle core biopsy may be performed on the area of concern to obtain a definitive diagnosis. The needle core biopsy would be assigned CPT code 60100. If a cyst exists, and requires aspiration or an injection, then 60300 would be the correct code. Imaging guidance codes may also be assigned with either of these procedures if performed. Coding professionals should bear in mind that if fine needle aspiration biopsies are done, the correct CPT codes for those procedures are 10004-10012 and 10021. If a thyroid cyst or adenoma must be excised or the isthmus transected, CPT code 60200 is appropriate.
Illustrated below are different methods that can be used to remove thyroid tissue. The subtotal thyroidectomy, also known as a partial lobectomy, codes to 60210. It is a unilateral procedure with the same code assigned whether or not an isthmusectomy is performed. In some circumstances, that procedure may be coupled with a contralateral subtotal thyroidectomy. In that case the isthmusectomy is included and the code assigned is 60212.
If an entire lobe of the thyroid is removed, 60220 is assigned. Again, this code is unilateral and includes an isthmusectomy if performed. 60225 is for the total lobectomy along with a contralateral subtotal lobectomy, which includes an isthmusectomy if performed.
A total thyroidectomy procedure is coded to 60240. When a thyroidectomy is performed to address a malignancy, regardless of whether it is a total or subtotal removal, different CPT codes will be assigned. These codes distinguish between a limited or radical neck dissection accompanying the thyroidectomy. The neck dissections or lymphadenectomies may be performed prophylactically to prevent the thyroid cancer from spreading or as a definitive treatment in cases where the thyroid cancer has already metastasized to the lymph nodes. Limited neck dissections means that not all lymph node levels will be taken and other structures, like blood vessels, nerves, and muscles may be spared. In a radical neck dissection, all the tissue on one side of the neck is removed. This will include muscles, nerves, major blood vessels, and salivary glands. The thyroidectomy with limited neck dissection codes to 60252, with the radical neck dissection performed in conjunction with the thyroidectomy coding to 60254.
Source: https://wjso.biomedcentral.com/articles/10.1186/1477-7819-3-21
A substernal thyroid is the enlargement of the thyroid gland extending through the thoracic outlet and into the thoracic cavity. This type of thyroid may also be called a retrosternal thyroid. When a thyroidectomy procedure is performed and includes removing substernal thyroid tissue, one of two codes is assigned. The approach is what differentiates the codes. The first code, 60270, is assigned when the procedure is done via a sternal split or transthoracic approach. The second code, 60271, should be used if the procedure is done via the cervical approach.
Source: https://basicmedicalkey.com/thyroidectomy-for-substernal-goiters/
Any time that a patient who
previously had a portion of their thyroid removed now requires all the
remaining thyroid tissue be excised, CPT code 60260 is the correct code to use. In this circumstance, if the procedure is
performed bilaterally, then modifier 50 should be reported as well.
Mentioned earlier were the four parathyroid glands that are situated behind the thyroid itself. Although surgeons try to ensure that the parathyroid glands remain intact as they perform a thyroid procedure, their proximity to the gland can make that difficult. A gland or glands may be removed or have their vascular supply compromised. In these instances, it is often decided to perform an autotransplantation of the parathyroid(s). This involves mincing the gland and then inserting it back into the patient via a pocket in the sternocleidomastoid muscle. Add-on code 60512 for parathyroid autotransplantation may be assigned in those circumstances. A note follows this code in the CPT manual detailing the base codes that 60512 may be assigned with.
Now, light has been shed on coding thyroid procedures.
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About the Author
Dianna Foley, RHIA, CHPS, CCS, CDIP, is an HIM professional with over 25 years of experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA, along with being an AHIMA-approved ICD-10-CM/PCS trainer. Dianna has held many positions in HIM and is now an independent coding consultant. She previously served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna is an AHIMA-published author and has volunteered with AHIMA on projects including certification item writing, certification exam development, coding rapid design, and most recently has served on AHIMA’s nominating committee. She is a presenter on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator. Dianna mentors new AHIMA members and also provides monthly educational lectures to coders and clinical documentation specialists.
