02-21-2025 Coding a Completion Thyroidectomy
Scenario: 43 YO non-hispanic white married male presents with a right thyroid nodule suspicious for papillary thyroid carcinoma. Based on the findings from the ultrasound, CT scan, and FNA, the patient is recommended for surgery. The following surgeries were performed as part of the patient’s first course treatment.
- 01/15/2025 Right lobectomy WITH isthmus
- 03/01/2025 Left lobectomy (completion thyroidectomy)
Question: How would you code the 03/01/2025 surgery?
- B251 Lobectomy ONLY (right or left)
- B500 Total Thyroidectomy
Answer: B500 Total Thyroidectomy
Rationale: The SEER Program Coding and Staging Manual provides detailed coding instructions for coding cancer cases. One important coding instruction is how to code the “Surgery of Primary Site” data item when there are multiple surgeries performed on the same organ. When part of the primary site has been resected in a prior procedure and a subsequent surgery removes the remaining portion of the organ, the SEER manual directs that the surgery be coded as a total removal of the primary site. The example of a completion thyroidectomy in the SEER manual demonstrates this approach.
In the above example:
- The initial surgery was a right lobectomy WITH isthmus, which removed one lobe of the thyroid gland along with the connecting isthmus.
- The second surgery was a completion thyroidectomy, which removed the remaining part of the thyroid.
In this case, even though the first surgery only removed part of the thyroid (the right lobe and isthmus), the second surgery completes the removal of the entire thyroid gland. Therefore, the correct surgical code for the subsequent surgery would be total thyroidectomy (B500), as it accurately reflects the outcome of the total thyroid removal after both surgeries.
Please also refer to SEER Appendix C and STORE Appendix A when coding thyroid surgeries, as well as specific forum discussions on the CAnswer Forum for coding a completion thyroidectomy.