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You may have your thyroidectomy work cut out for you.

Question 1: What is the difference between a hemi-thyroidectomy and a completion thyroidectomy?

Answer: In a hemi-thyroidectomy, the surgeon excises half of the thyroid, usually due to the presence of a tumor or mass. This operation also involves the removal of the pyramidal lobe, a structure that connects the two thyroid halves. The goal of this procedure is to preserve one half of the thyroid, enabling the patient to continue producing thyroid hormones naturally. This procedure is considered less risky than a total thyroidectomy, as it minimizes the risk to the remaining parathyroid glands and the recurrent laryngeal nerve.

You would use code 60220 (Total thyroid lobectomy, unilateral; with or without isthmusectomy) for this procedure.

During a completion thyroidectomy, a procedure carried out on patients who have previously had a hemi-thyroidectomy but are later found to have cancer on the unremoved side of the thyroid. The surgeon then proceeds to extract the remaining part of the thyroid to ensure complete removal of all cancerous cells from the patient鈥檚 body. This operation can be complex due to the potential scarring from the initial surgery, necessitating a high level of precision and attention to detail.

You would use code 60260 (Thyroidectomy, removal of all remaining thyroid tissue following previous removal of a portion of thyroid) for this procedure.

Helpful tip: Your surgeon may not always use the words 鈥渃ompletion鈥� or 鈥渉emi鈥� in their documentation of a thyroid lobectomy, which is why it鈥檚 essential that you鈥檙e able to spot certain keywords in the documentation that can lead you to the most accurate code.

If the physician documents 鈥渢hyroid lobectomy,鈥� they are most likely referring to a hemi-thyroidectomy (60220).

If they document scarring from a previous lobectomy, then they are most likely describing a completion thyroid lobectomy (60260).

Question 2: What is the difference between a 鈥渘odule鈥� and a 鈥済oiter鈥� when it comes to thyroid diagnosis coding?

Answer: Due to the complexity of the answer, let鈥檚 review a coding scenario first:

A patient diagnosed with hyperthyroidism was found to have an additional single thyroid nodule during an ultrasound. However, since the physician did not specify that it was a goiter, which ICD-10-CM code(s) should be applied?

Answer: A single thyroid nodule, on its own, codes as E04.1 (Nontoxic single thyroid nodule). However, you will want to factor in the diagnosis of hyperthyroidism.

If you take a step back and look at the E05.- code list, you will see that the correct option exists in code E05.10 (Thyrotoxicosis with toxic single thyroid nodule without thyrotoxic crisis or storm).

Beware: If you search for this diagnosis using the term 鈥渘odule鈥� as your primary search keyword, you will be directed to E05.20 (Thyrotoxicosis with toxic multinodular goiter without thyrotoxic crisis or storm) via the ICD-10-CM index. However, if you use 鈥渉yperthyroidism鈥� as the primary search term, you will be directed to E05.10.

Total transparency: The term 鈥済oiter,鈥� as defined by the American Thyroid Association, refers to 鈥渢he abnormal enlargement of the thyroid gland.鈥� By this definition, the description of a simple thyroid nodule meets the criteria for a goiter. However, ICD-10-CM coding relies exclusively on the wording of the diagnosis. So even if some words have interchangeable meanings, it鈥檚 important not to code a particular symptom or disease if the index does not lead you directly to it.

Take note: A documented thyroid lesion does not necessarily imply the presence of a nodule or goiter. While some coders are inclined to code 鈥渢hyroid lesion鈥� using E04.1 (Nontoxic single thyroid nodule) or E04.9 (Nontoxic goiter, unspecified), these would be incorrect. Instead, you will want to use E07.9 (Disorder of thyroid, unspecified) for thyroid lesions without any additional descriptive information.

Question 3: When would a modifier be appropriate for a lobectomy procedure?

Answer: In certain instances, it might be necessary to attach a modifier to the lobectomy code to accurately represent the specifics of the surgical procedure performed by your surgeon. For instance, if your surgeon records a completion thyroidectomy conducted on both thyroid lobes, you鈥檒l append modifier 50 (Bilateral procedure) to 60260. Unlike 60240 (Thyroidectomy, total or complete), which includes the resection of both thyroid lobes, 60260 alone represents the removal of only one lobe after prior thyroid surgeries, so that is why removal of both lobes would require the 50 modifier with 60260.

While in other scenarios, the physician may need to perform a completion thyroidectomy within the 90-day global period of the total thyroidectomy to ensure that all malignant cells are removed. In this case, you鈥檒l have to append modifier 58 (Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period) to 60260.

Take note: Adding modifier 58 to code 60260 could result in a medically unlikely edit (MUE) due to the implication that more than two thyroid lobes have been excised, given the characteristics of these codes. Sometimes, a hemi-lobectomy is reported, yet there is residual tissue that needs to be excised and documented with the completion code. If required, this can be contested and reversed on appeal.

Lindsey Bush, BA, MA, CPC, Development Editor, AAPC