Bilateral Neck Dissection with Thyroidectomy Claims

Published: 07th June 2011
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Otolaryngology coding can spring a lot of surprises for you. To cite an instance, let's say your surgeon plans to carry out a bilateral neck dissection with thyroidectomyand trachea resection however ends up having to also perform plate stabilization for access to the lymph nodes in the superior mediastinum. You can overcome this challenge with a thorough review of the documentation and careful use of modifiers.

If you need further proof, take into consideration the following op report. After you review the op note, code the procedure prior to checking out our expert advice below.

Preoperative diagnosis: Medullary carcinoma of the right lobe of the thyroid, stage T4-A, N1-B, M0.

Procedure overview: One more ENT previously started a total thyroidectomy on this patient; however that the cancer was eroding into the trachea; as such he referred the patient to this surgeon. The new surgeon carried out a right modified radical neck dissection with preservation of the spinal accessory nerve and sternocleidomastoid muscle, as well as a left selective neck dissection, removing the lymph node levels II through IV. He also carried out a right thyroidectomy, a resection of the right lateral trachea, and osteotomy of the right clavicle with plate stabilization for access to lymph nodes in the superior mediastinum.

Op Note: Trace the surgeon's work

The relevant details of the op report: We carried out a modified radical neck dissection on the right neck, with preservation of the spinal accessory nerve and sternocleidomastoid muscle. We figured out that the internal jugular vein was involved by disease at level IV, and as such sacrificed the internal jugular vein along with the rest of the neck contents. As we tracked the disease near the phrenic nerve, we saw that the disease was tracking down into the superior mediastinum and possibly involved the right subclavian vein.

In order to offer better exposure to the vasculature in the superior mediastinum, we fractured the clavicle using a Gigli saw. We removed the lymph nodes that were tracking down along the carotid artery and jugular vein. Then we carried out a left neck dissection, removing lymph node levels II, III and IV.

We separated the fascia from the deep surfaces of the sternocleidomastoid muscle, which allowed us to remove the lymph node tissue from levels II, III and IV, thus bringing it anteriorly across the great vessels. As soon as we had it into the anterior aspect of temperature neck, we terminated the specimen and sent it to pathology.

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