AHA Coding Clinic® for HCPCS - 2022 Issue 2; Ask the Editor

Hemi-thyroidectomy with isthmusectomy and central neck dissection

A patient with a nodule suspicious for thyroid cancer presents for a right hemi-thyroidectomy with isthmusectomy and central neck dissection. Curvilinear incision was made, subplatysmal flaps were raised and the midline superficial fascia was divided. Right strap muscles were retracted exposing the large thyroid gland with midpole nodularity. The lobe was mobilized and vascular pedicles were controlled with clamps and clips. Two parathyroid glands were preserved and the right recurrent laryngeal nerve (RLN) was intact. Once the Berry ligament was dissected out, the right thyroid lobe was fully mobilized off the tracheal ring and the large isthmus was separately resected. Once this was complete, the area of the isthmus resection was oversewn with sutures.Next, the central neck dissection was started by excising the lymph nodes above the thyroid and the superior compartment (Delphian node). With inspection of the right inferior paracentral and pretracheal neck dissection, it was felt the risks outweighed the benefits of continued dissection along the recurrent laryngeal nerve (RLN). Therefore, the inferior central neck dissection was aborted. Four nodes and adenomatoid thyroid tissue with Hurthle cell features were removed. We are aware there are codes for a subtotal thyroidectomy with radical and limited neck dissections. How is the hemi-thyroidectomy or thyroid lobectomy with an isthmusectomy and a central neck dissection appropriately coded? ...

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