How to Code a THYROIDECTOMY
Thyroid Gland
The thyroid gland is one of the endocrine glands in the human body. It plays a significant role in the metabolism of the body cells through the secretion of Thyroxine (T4) and triiodothyronine (T3) (hormones)into the blood.
Too many thyroid hormones (hyperthyroidism/overactive thyroid) increases the activity of the body cells or organs, e.g., Increased heart rate and increased intestinal activity leading to frequent bowel motions.
On the other hand, too few thyroid hormones (hypothyroidism/underactive thyroid) have a slowdown effect, e.g., reduced heart rate and intestinal activity, causing constipation.
Thyroidectomy
Thyroidectomy procedures involve surgical removal of all or part of the thyroid gland. Thyroidectomy is mainly classified into partial thyroidectomy and Total thyroidectomy.
Patients, after total thyroidectomy, will need daily thyroid hormone treatment to replace the natural thyroid function. Meanwhile, post partial thyroidectomy, thyroid hormone will work normally.
Thyroidectomy CPT Coding
The codes series ranging from 60210-60271 describe various thyroid excision procedures.
| 60210 | Partial thyroid lobectomy, unilateral; with or without isthmusectomy |
| 60212 | with contralateral subtotal lobectomy, including isthmusectomy |
| 60220 | Total thyroid lobectomy, unilateral; with or without isthmusectomy |
| 60225 | with contralateral subtotal lobectomy, including isthmusectomy |
| 60240 | Total thyroid lobectomy, unilateral; with or without isthmusectomy |
| 60252 | Thyroidectomy, total or subtotal for malignancy; with limited neck dissection |
| 60254 | with radical neck dissection |
| 60260 | Thyroidectomy, removal of all remaining thyroid tissue following previous removal of a portion of thyroid |
| 60270 | Thyroidectomy, including substernal thyroid; sternal split or transthoracic approach |
| 60271 | cervical approach |
60210 – Partial thyroid lobectomy, unilateral; with or without isthmusectomy
Portion of one thyroid lobe is removed including the isthmus, if performed.
60212- with contralateral subtotal lobectomy, including isthmusectomy
Portions of both lobes are removed along with the isthmus.
60220 -Total thyroid lobectomy, unilateral; with or without isthmusectomy
One entire thyroid lobe is removed including the isthmus, if performed.
60225 -with contralateral subtotal lobectomy, including isthmusectomy
One entire thyroid lobe is removed including the isthmus and most part, but not all, of the opposite
thyroid lobe.
Codes 60240-60271 are generally reported for excision of thyroid tissue because of more complex benign conditions (e.g. very large goiter) or malignancy. These conditions may also require neck dissection, a surgical procedure for the evaluation and control of neck lymph node metastasis.
60240 – Thyroidectomy, total or complete
The procedure involves surgical removal of the entire thyroid gland. Surgeon utilizes a standard neck incision, typically measuring about 4-5 inches in length. The surgeon must be careful of the laryngeal nerves that are very close to the back side of the thyroid and are responsible for the movement of the vocal cords. Damage to a nerve will cause hoarseness of the voice, which, although it is usually temporary, may be permanent, although this is an uncommon complication.
60252 -Thyroidectomy, subtotal or total for malignancy, with limited neck dissection.
Code represents a total thyroidectomy with limited lymph node dissection. The physician
removes malignant and some lymph nodes. The physician exposes the thyroid via a transverse cervical incision in the skin line. The platysma is divided, and the strap muscles are separated in the midline. The thyroid gland is mobilized, and the superior and inferior thyroid vessels are ligated. The parathyroid glands are preserved, the thyroid is resected free of the trachea, and removed enlarged lymph nodes are identified and excised. The platysma and skin are closed.
60254– with radical neck dissection:
Code represents a total thyroidectomy with radical neck dissection.
60260– Thyroidectomy, removal of all remaining thyroid tissue following the previous removal of a
a portion of the thyroid.
The parenthetical note following code 60260 instructs users to append modifier 50 for a completion thyroidectomy when tissue is resected from both sides of the neck. Technically, if a complete thyroidectomy is performed, it may not be a bilateral lobectomy. For example, in the event that a left thyroid lobectomy is performed, and two days later, a right thyroid lobectomy is performed, code 60260 without modifier 50 appended, as it represents re-entering an already operated field to
remove all remaining residual thyroid tissue following the previous removal of a portion of the thyroid gland.
Another example would be when a left partial thyroid lobectomy is performed two days later by completion (total) thyroidectomy. In this situation, the removal of the remainder of the left lobe,
isthmus and the right lobe would be reported with code 60260 with both modifiers 50 and 58 appended.
Please refer to the operative report to determine the specific completion thyroidectomy procedure
performed.
60270– Thyroidectomy, including 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.
60271– cervical approach
The procedure involves surgical removal of the thyroid gland, including its extension into the thorax below the sternum.
References
- American Medical Association. CPT Assistant. 2010 (8):3.
- MCG 2023 Absolute Medical Coding Instittue – https://www.amcicoding.com/mcg
- American Thyroid Association. “Consensus review and statement regarding the anatomy,
terminology, and rationale for lateral neck dissection in differentiated thyroid cancer.” Thyroid.
2012;22(5):501-508. - Stack, Jr. BC, Ferris, RL, Goldenberg D, Haymart M, et al. “American Thyroid Association (ATA)
Consensus Review of the Anatomy, Terminology and Rationale for Lateral Neck Dissection in
Differentiated Thyroid Cancers.” Thyroid. 20l2; 22(5): 501-508. - Cooper DS, Doherty GM, et al. “Revised American Thyroid Association management guidelines for
patients with thyroid nodules and differentiated thyroid cancer.” American Thyroid Association (ATA)
Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2009;19(11):1167-
1214. - Carty SE, Cooper DS, Doherty GM, et al. “Consensus statement on the terminology and classification
of central neck dissection for thyroid cancer.” Thyroid. 2009; 19(11):1153-1158.
About the Blogger
Sandeep V.S
Sandeep is a Certified Medical Coder with over seven years of experience in medical coding industry. He has worked in several projects from Middle East to the United States. He worked in multi-specialty departments as a specialist outpatient E/M coder and inpatient coder. He completed post graduation in Pharmacy in 2015. Sandeep is a Co-lead instructor with Absolute Medical Coding Institute and an inpatient medical coder with New National Medical Center Hospital, (Dubai).