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CPT Endocrine System Guidelines

ENDOCRINE SYSTEM (60000 – 60699)

FORMAT:

There are nine glands in the endocrine system but only four are included in the Endocrine subsection (60000-60699) of the CPT manual.

The four glands in the Endocrine subsection are:
- Thyroid (60000-60300)
- Parathyroid (60500-60512)
- Thymus (60520-60522)
- Adrenal (60540-60545, 60650)

The pituitary and pineal gland codes are in the Nervous System subsection of the CPT manual, the pancreas codes are in the Digestive System subsection, and the ovaries and testes codes are in the respective Female or Male Genital System subsections.

CODING HIGHLIGHTS:

The Endocrine System subsection (60000 – 60699) include two subheadings of:
Thyroid Gland
Parathyroid, Thymus, Adrenal Glands, Pancreas, and Carotid Body

Thyroid Gland:

The thyroid gland is composed of a right and left lobe on either side of the trachea, just below a large piece of cartilage (thyroid cartilage).
Two of the hormones secreted by the thyroid gland are T3 (triiodothyronine) and T4 (thyroxine). The thyroid gland normally produces 80% T4 and 20% T3. These hormones are necessary to maintain the normal level of metabolism in the cells of the body.
Thyroid Function Tests (TFTs) assess the levels of hormones produced by the thyroid gland. Within the Thyroid Gland subheading in the CPT manual (60000-60300) there are the categories of Incision, Excision, and Removal.

Thyroid Gland (Incision & Excision)

A thyroidectomy is the removal of all or part of the thyroid gland. The thyroid gland consists of two lobes, one on each side of the throat, connected by a narrow band of thyroid tissue (isthmus). The term “thyroidectomy” can apply to a total removal of the gland (total thyroidectomy), removal of one or part of one of the lobes (lobectomy), or the isthmus (isthmusectomy).
A thyroidectomy is performed to assist in treatment of various thyroid diseases, such as thyroid nodules, hyperthyroidism (overactive thyroid gland), cancer of the thyroid gland, or enlargement of the thyroid (goiter) that may cause breathing or swallowing difficulties.
The amount of thyroid tissue removed is determined prior to the surgical procedure. The surgeon works closely with an endocrinologist (a physician specializing in gland tissue disorders) to determine the thyroid gland function and the amount of tissue to remove. Usually thyroid function tests (blood tests) and thyroid scanning are performed before the procedure. For cases in which thyroid cancer is suspected, a biopsy may also be performed.
A partial thyroid lobectomy is reported with 60210 or 60212 and is not performed often.
Total thyroid lobectomy (60220 or 60225) is typically the least complex operation performed on the thyroid gland. It is performed for solitary nodules that are suspected to be cancerous or those that are indeterminate following biopsy, such as follicular adenomas, solitary nodules, or goiters that are isolated to one lobe (not common). The procedure may or may not include an isthmusectomy (removal of the part that connects the two thyroid lobes) because the code description states “with or without isthmusectomy.”

An isthmusectomy removes more thyroid tissue than a simple lobectomy and is performed when a larger margin of tissue is needed to assure that all suspect tissue has been removed.

Subtotal thyroidectomy (60210, 60212, 60252, 60254) is performed to excise all questionable tissue on the side of the gland as well as the isthmus and the majority of the opposite lobe. This operation is typical for small, nonaggressive thyroid neoplasms. It is also a common operation for goiters that result in problems in the neck or those that extend into the chest (substernal goiters).

Total thyroidectomy (60240, 60252) removes all of the thyroid gland and is often the procedure of choice for thyroid neoplasms that are larger and/or aggressive. Many surgeons prefer the complete removal of thyroid tissue in those patients with thyroid neoplasms regardless of the type of neoplasm.
The technique for a thyroidectomy utilizes a standard neck incision typically measuring about 4-5 inches in length.
Many surgeons perform this procedure through an incision as small as 3 inches.
The incision is made in the lower part of the central neck and typically involves the removal of that part of the thyroid that contains the suspect tissue. The surgeon must be careful of the laryngeal nerves that are very close to the back side of the thyroid and are responsible for movement of the vocal cords.
Damage to a nerve will cause hoarseness of the voice, which although it is usually temporary, may be permanent, although this is an uncommon complication (about 1% to 2%).

A cyst may form on the thyroid and a surgeon may aspirate and/or inject the cyst. The service is reported with 60300. As with other aspiration/injection codes, if the surgeon provides an aspiration and injection, both procedures are reported with one unit of the code (60300), not two units (60300 × 2)

Parathyroid Gland:

Parathyroid glands are four small oval bodies located on the dorsal aspect (back) of the thyroid gland.
These glands secrete parathyroid hormone (PTH). That mobilizes calcium from bones into the bloodstream, which is necessary for the proper functioning of body tissues, especially muscles.
Within the Parathyroid, Thymus, Adrenal Glands, Pancreas, and Carotid Body subsection (60500-60699) there are categories Excision, Laparoscopy, and Other Procedures.

Adrenal glands (suprarenal) are two small glands situated one on top of each kidney. There are two parts to each gland, the cortex (outer portion) and the medulla (inner portion). The cortex secretes the hormones corticosteroids, and the medulla secretes the hormones catecholamines.

The thymus gland is located behind the breast bone, in front of the heart, and is involved in maturation (development) of the immune system. Thymectomy is removal of the thymus and is usually performed by cutting through the breast bone, similar to heart surgery.

The pancreas is an organ that is located behind the stomach, and the head of the organ is attached to the duodenum (first section of the small intestine). Although the organ is listed in the heading (Parathyroid, Thymus, Adrenal Glands, Pancreas, and Carotid Body), the codes for procedures involving the pancreas are located in the Digestive System subsection (48000-48999).

The carotid body is tissue rich in capillaries that act as receptors located near the bifurcation (splitting into two) of the carotid arteries. The receptors monitor arterial oxygen content and pressure. Tumors that develop in the carotid body may be excised and the service reported with 60600 or 60605.

All endocrine glands are ductless, which means they secrete hormones directly into the bloodstream rather than through ducts leading to the exterior of the body. Exocrine glands send their chemical substances into ducts and then out of the body. Examples of exocrine glands are sweat, mammary, mucous, salivary, and lacrimal (tear ducts).

Parathyroid Gland (Excision)

Parathyroidectomy is performed through an incision made above the collar bone that is approximately 4 inches in length. The four parathyroid glands are located by the surgeon and removed, a drain is inserted at either end of the incision, and sutures or surgical clips are applied.

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