How to Code a THYROIDECTOMY

Thyroid Gland

The thyroid gland is a crucial component of the endocrine system, responsible for regulating metabolism through the secretion of hormones like thyroxine (T4) and triiodothyronine (T3). Understanding the functions of the thyroid gland and the implications of procedures such as thyroidectomy is vital for healthcare providers and coders.

When the thyroid gland produces too many hormones, a condition known as hyperthyroidism or an overactive thyroid occurs. This situation increases the activity of body cells or organs. For instance, individuals may experience an increased heart rate and heightened intestinal activity, leading to frequent bowel movements.

Conversely, insufficient thyroid hormones result in hypothyroidism or an under actve thyroid. This condition slows down bodily functions, causing reduced heart rate and intestinal activity, often resulting in constipation.

Thyroidectomy

Thyroidectomy involves the surgical removal of all or part of the thyroid gland. The procedure is primarily classified into two types: partial thyroidectomy and total thyroidectomy.

Patients who undergo total thyroidectomy will require daily thyroid hormone treatment to replace the natural function of the thyroid. Meanwhile, individuals who have a partial thyroidectomy typically find that their thyroid hormone levels stabilize and function 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. thyroid gland

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 One entire thyroid lobe is removed including the isthmus and most part, but not all, of the opposite
thyroid lobe.

Codes 60240-60271 typically describe the excision of thyroid tissue, especially in cases involving complex benign conditions, such as a very large goiter. Additionally, these conditions often require neck dissection, a surgical procedure that evaluates and controls neck lymph node metastasis. Furthermore, understanding these codes and their applications ensures accurate billing and coding.

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.In some cases, damage to a nerve may cause hoarseness of the voice. While this effect is usually temporary, it is important to note that it may become permanent, although this complication is uncommon

60252 

Thyroidectomy, subtotal or total for malignancy, with limited neck dissection: This code represents a total thyroidectomy with limited lymph node dissection. The physician removes malignant tissue and some lymph nodes. The thyroid is accessed via a transverse cervical incision, allowing for the division of the platysma and separation of the strap muscles in the midline. The surgeon mobilizes the thyroid, ligates the superior and inferior thyroid vessels, and preserves the parathyroid glands. After resecting the thyroid, the surgeon excises any enlarged lymph nodes. The platysma and skin are then closed.

60254 

With radical neck dissection: This code signifies a total thyroidectomy combined with a radical neck dissection.

60260

Thyroidectomy for Remaining Tissue: Append modifier 50 for completion thyroidectomy if tissue is resected from both neck sides. Report 60260 when re-entering to remove remaining tissue. For left lobectomy followed by right lobectomy, use 60260 without modifier 50. For left partial lobectomy followed by total thyroidectomy, report 60260 with modifiers 50 and 58. Always check the operative report for specifics.

60270 

Thyroidectomy, including substernal thyroid; sternal split or transthoracic approach: This procedure entails the removal of the thyroid gland, including any extension below the breastbone. Surgeons typically perform this procedure for complex benign conditions, such as large goiters, or for malignant conditions extending into the upper chest.

60271 

Cervical approach: This procedure involves the surgical removal of the thyroid gland, including any extension into the thorax below the sternum.

References

1. American Medical Association. CPT Assistant. 2010 (8):3.
2. MCG 2023 Absolute Medical Coding Instittue – https://www.amcicoding.com/mcg
3. 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.
4. 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.
5. 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.
6. 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 has worked on various projects ranging from the Middle East to the United States. He has experience in multi-specialty departments, serving as both a specialist outpatient E/M coder and an inpatient coder. Sandeep completed his postgraduate degree in Pharmacy in 2015. Currently, he is a co-lead instructor at the Absolute Medical Coding Institute and an inpatient medical coder.