Thyroid surgery is a common procedure in which all or a portion of the thyroid gland is removed. Also known as thyroidectomy, this surgical procedure is used to treat several thyroid disorders such as cancer, non-cancerous enlargement of the thyroid (goiter) and overactive thyroid (hyperthyroidism). The thyroid is a butterfly-shaped endocrine gland located at the base of your neck, intricately placed right on top of the windpipe and next to the food pipe. The thyroid produces hormones that regulate every aspect of your metabolism (right from your heart rate to how quickly you burn your calories). If the thyroid enlarges, it can squeeze these important structures and cause problems with breathing or swallowing. One of the most common reasons for conducting a thyroid surgery is the presence of nodules or tumors on the thyroid gland. Most nodules are benign, but some can be cancerous or precancerous. However, benign nodules can also cause problems if they grow large enough to obstruct the throat or if they stimulate the thyroid or overproduce hormones (a condition called hyperthyroidism). Early and accurate diagnosis of thyroid disorders is a difficult task as in most cases the symptoms develop slowly (often over several years). General surgery medical billing and coding is quite complex, as there are several rules related to reporting the procedure accurately. General surgeons or ENT surgeons performing thyroid surgery should correctly document the procedures performed in the patients’ medical records. Medical coding outsourcing is a practical solution for physicians to simplify their documentation process.

Thyroid Surgery

Here are some frequently asked questions and answers about thyroid surgery –

Q: Why is thyroid surgery performed?

A: One of the most common reasons for thyroid surgery is the presence of abnormal growths or nodules (lumps) on the thyroid gland. In most cases, the nodules range in size from several millimeters to centimeters and could be cancerous. Surgery may be recommended for conditions like Goiter (Noncancerous enlargement of the thyroid) and Hyperthyroidism (Overactive thyroid). However, not every patient with thyroid nodules requires surgery. The main decision whether to conduct a surgery or not is taken after careful consideration of the patient’s medical history and the results of the tests done to evaluate the nodules and the functioning of the thyroid gland.

Q: What are the different types of thyroid surgery?

A: There are three different types of thyroid surgery namely – Lobectomy, Subtotal thyroidectomy and Total thyroidectomy.

  • Thyroid lobectomy – one half of the thyroid is removed.
  • Subtotal thyroidectomy – the thyroid gland is removed but a small amount of thyroid tissue is left behind (which preserves some thyroid function).
  • Total thyroidectomy – the entire thyroid gland is removed.

Q: What are the potential risks or complications involved?

A: Generally, thyroidectomy is a safe procedure. However, as with any other procedure, thyroid surgery has its own set of complications –

  • Bleeding
  • Infection
  • Airway obstruction caused by bleeding
  • Permanent hoarse or weak voice due to nerve damage
  • Recurrent laryngeal nerve injury
  • Low blood calcium

Q: Who performs the procedure?

A: In most cases, Thyroidectomy is performed by physicians specialized in otolaryngology, head and neck surgery.

Q: How long will a patient need to stay in the hospital for thyroid surgery?

A: Patients will be admitted to the hospital on the day of the surgery. In most cases, they are able to go home the same day after about 4-8 hours in the recovery room, depending on the extent of incision and timing of the surgery.

Q: What type of anesthesia is given to the patient as part of the surgery?

A: Patients are given either general anesthesia or local anesthesia at the time of the surgery. With both techniques, the surgeon will perform a nerve block so that the neck area is numbed.

Q: How are thyroid problems diagnosed?

A: Thyroid problems don’t develop rapidly. In some cases, the patient’s symptoms may be quite hard to distinguish or may be similar to other disorders. Before performing a surgery, a number of diagnosis and screening tests are conducted to determine the nature and type of thyroid disease. Laboratory analysis of blood determines the amount of active thyroid hormones circulating in the body. A TSH (thyroid stimulating hormone) test is one of the most common blood tests that helps check the thyroid hormones in the blood stream. Sonograms and CT scans may also be conducted to determine the size of the thyroid gland and location of abnormalities. In addition, a needle biopsy of the abnormality or aspiration of fluid from the thyroid gland may also be performed to determine the diagnosis. If the diagnosis is hyperthyroidism, patients may be asked to consume anti-thyroid medicine before the surgery.

Endocrinologists who provide specialized treatment are reimbursed for the services provided to the patients. Correct medical codes must be used to document the diagnosis, screening and other procedures performed. Medical billing and coding services offered by reputable companies can help physicians use the correct codes for their medical billing process.

Q: What are the medical codes used for documenting thyroid surgery?

A: The following ICD-10 codes and CPT codes are relevant with regard to thyroid surgery –

ICD – 10 Codes

  • E89.0 – Postprocedural hypothyroidism

CPT Codes

  • 60500 – Parathyroidectomy or exploration of parathyroid(s)
  • 60502 – Parathyroidectomy or exploration of parathyroid(s); re-exploration
  • 60505 – Parathyroidectomy or exploration of parathyroid(s); with mediastinal exploration, sternal split or transthoracic approach
  • 60212 – Partial thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomy
  • 60225 – Total thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomy
  • 60240 – Thyroidectomy, total or complete
  • 60252 – Thyroidectomy, total or subtotal for malignancy; with limited neck dissection
  • 60254 – Thyroidectomy, total or subtotal for malignancy; 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 – Thyroidectomy, including substernal thyroid; cervical approach

Q: How are patients evaluated prior to the surgery?

A: All patients undergoing thyroid surgery will be evaluated pre-operatively by conducting a thorough medical history review and detailed physical exam including cardiopulmonary (heart and lungs) evaluation. An electrocardiogram and a chest x-ray are often recommended for patients above 45 years of age or who are symptomatic from heart disease. In addition, blood tests may also be done to determine if a bleeding disorder is present.

Q: What patient preparations are required for the procedure?

A: Prior to your operation (at least one week before the procedure), patients will be seen by the anesthesiologist for a preoperative check. Patients will be asked questions about all the medications they are consuming and instructions will be given whether to stop or continue these medications prior to the procedure. Some of the most important preparation tips include –

  • Do not eat or drink anything after midnight on the night before surgery. However, patients can consume routine medicines for heart disease, blood pressure, or asthma on the morning of the surgery with a small sip of water.
  • Stop taking aspirin and other blood-thinning products (such as Coumadin, ibuprofen and Plavix) at least 7-10 days before surgery, unless otherwise directed by the physician.

Q: Will patients experience pain after the operation?

A: Patients will experience some pain soon after the surgery, but this can be effectively treated with small doses of pain medications. However, patients may experience conditions such as sore throat, difficulty swallowing, or a hoarse voice, all of which will subside quickly.