How To Use CPT Code 60254

CPT 60254 describes the surgical procedure of total or subtotal thyroidectomy for malignancy, along with radical neck dissection. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 60254?

CPT 60254 is used to describe the surgical removal of the entire thyroid or most of the thyroid, including the isthmus, for malignancy. This procedure also involves a radical neck dissection, which aims to remove extensive neck structures, including malignant lymph nodes in the neck. It is important to note that this code is specifically used for cases involving malignancy.

2. Official Description

The official description of CPT code 60254 is: ‘Thyroidectomy, total or subtotal for malignancy; with radical neck dissection.’

3. Procedure

1. The patient is prepared and anesthetized.
2. The provider makes an extended neck incision, considering factors such as access, cosmetic appearance, and blood supply to the resultant flaps.
3. The skin is separated into upper and lower flaps, and the overlying muscles are divided.
4. The provider gains a view of the thyroid and cuts and ties the ends of the thyroid vessels that provide blood circulation to the thyroid.
5. All or most of the thyroid is removed, taking care to avoid injury to the adjacent recurrent laryngeal nerve that innervates the vocal cord.
6. The provider performs a radical neck dissection, removing neck structures extensively, including malignant cervical lymph nodes, greater auricular nerves, digastric muscle, stylohyoid muscle, spinal accessory nerve, internal jugular vein, and sternocleidomastoid muscle.
7. Hemostasis is achieved to stop bleeding.
8. The overlying muscles and skin are closed in layers.

4. Qualifying circumstances

CPT 60254 is performed when there is a diagnosis of malignancy in the thyroid gland, requiring the surgical removal of the entire thyroid or most of it. The procedure also includes a radical neck dissection to remove extensive metastatic tissue in the neck, including malignant lymph nodes and other neck structures.

5. When to use CPT code 60254

CPT code 60254 should be used when performing a total or subtotal thyroidectomy for malignancy, along with a radical neck dissection. It is important to ensure that the procedure is being performed for a malignant condition and not for other indications. Other codes should be used for different types of thyroidectomies or neck dissections.

6. Documentation requirements

To support a claim for CPT 60254, the following documentation is required:

• Diagnosis of malignancy in the thyroid gland
• Details of the radical neck dissection performed
• Description of the extent of thyroidectomy (total or subtotal)
• Operative notes describing the steps of the procedure
• Documentation of any complications or unexpected findings
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 60254, ensure that the procedure performed is a total or subtotal thyroidectomy for malignancy, along with a radical neck dissection. It is important to follow the specific documentation requirements and provide accurate diagnosis coding. Additionally, be aware of any specific billing guidelines or modifiers that may apply to this procedure.

8. Historical information

CPT 60254 was added to the Current Procedural Terminology system on January 1, 1990. The code has not undergone any updates since its addition. However, it is important to stay updated with any changes or revisions in the future.

9. Examples

1. A patient undergoes a total thyroidectomy with radical neck dissection for malignant thyroid cancer.
2. A provider performs a subtotal thyroidectomy with radical neck dissection for metastatic thyroid carcinoma.
3. A patient with anaplastic thyroid cancer undergoes a total thyroidectomy and extensive neck dissection.
4. A provider performs a subtotal thyroidectomy with radical neck dissection for papillary thyroid carcinoma.
5. A patient with medullary thyroid carcinoma undergoes a total thyroidectomy and comprehensive neck dissection.
6. A provider performs a subtotal thyroidectomy with radical neck dissection for follicular thyroid carcinoma.
7. A patient with poorly differentiated thyroid cancer undergoes a total thyroidectomy and extensive neck dissection.
8. A provider performs a subtotal thyroidectomy with radical neck dissection for Hürthle cell carcinoma.
9. A patient with anaplastic thyroid cancer undergoes a total thyroidectomy and comprehensive neck dissection.
10. A provider performs a subtotal thyroidectomy with radical neck dissection for metastatic thyroid lymphoma.