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60240

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🩺CPT 60240 - Thyroidectomy, Total or Complete

Code Description

Official Descriptor: Thyroidectomy, total or complete

This code represents the surgical removal of the entire thyroid gland. The procedure is performed through a standard cervical collar incision (Kocher incision) in the lower anterior neck. The surgeon carefully identifies and preserves critical structures including the recurrent laryngeal nerves and parathyroid glands while completely excising all thyroid tissue from both lobes and the isthmus.

Procedure Overview

Surgical Approach

The total thyroidectomy procedure involves a systematic approach to safely remove the entire thyroid gland. The surgeon makes a transverse cervical incision approximately 2-3 cm above the sternal notch, following natural skin lines for optimal cosmetic results. After raising subplatysmal flaps and dividing the strap muscles, the thyroid gland is exposed and mobilized.

Key Surgical Steps

  • Exposure and Identification: The thyroid gland is exposed and the middle thyroid veins are ligated and divided
  • Superior Pole Dissection: The superior thyroid vessels are individually ligated close to the thyroid capsule to preserve external branch of superior laryngeal nerve
  • Inferior Pole Dissection: The inferior thyroid vessels are identified and preserved when possible to maintain parathyroid gland blood supply
  • Recurrent Laryngeal Nerve Identification: The recurrent laryngeal nerve is carefully identified and preserved throughout its course in the tracheoesophageal groove
  • Parathyroid Preservation: All visible parathyroid glands are identified and preserved with their blood supply intact
  • Isthmus Division: The thyroid isthmus is divided and the tracheal surface is cleared
  • Specimen Removal: The entire thyroid gland is removed and sent for pathological examination
  • Hemostasis and Closure: Meticulous hemostasis is achieved and the wound is closed in layers

Includes

The following services and components are included in CPT 60240 and should NOT be reported separately:

  • Complete removal of both thyroid lobes
  • Removal of the thyroid isthmus
  • Pyramidal lobe removal when present
  • Identification and preservation of recurrent laryngeal nerves
  • Identification and preservation of parathyroid glands
  • Standard cervical lymph node sampling (palpation only)
  • Local hemostasis and wound closure
  • Standard surgical approach via cervical collar incision
  • Intraoperative nerve monitoring when performed (separate code may apply)
  • Exploration of neck for parathyroid glands

Excludes

The following procedures are NOT included in 60240 and should be reported separately when performed:

  • Parathyroidectomy (60500): Removal of one or more parathyroid glands
  • Parathyroid Autotransplantation (60512): Reimplantation of parathyroid tissue
  • Neck Dissection (limited 60252, radical 60254): When performed for malignancy with lymph node dissection
  • Thymectomy (60520-60540): Removal of thymus gland
  • Laryngoscopy (31500-31579): Postoperative laryngoscopy is included in global period but diagnostic laryngoscopy before decision for surgery may be separately reportable
  • Intraoperative Nerve Monitoring (64590): May be separately reportable with modifier 59
  • Frozen Section Pathology (88331): Intraoperative pathological consultation
  • Completion Thyroidectomy (60260): When removing remaining lobe after previous lobectomy

ICD-10-CM Diagnosis Codes

Malignant Neoplasms

C73 - Malignant neoplasm of thyroid gland

  • Papillary thyroid carcinoma
  • Follicular thyroid carcinoma
  • Medullary thyroid carcinoma
  • Anaplastic thyroid carcinoma
  • Hürthle cell carcinoma

Benign Neoplasms

D34 - Benign neoplasm of thyroid gland

  • Follicular adenoma
  • Hürthle cell adenoma
  • Toxic adenoma

Goiter and Thyromegaly

E04.0 - Nontoxic diffuse goiter

  • Simple goiter
  • Colloid goiter
  • Parenchymatous goiter

E01.0 - Iodine-deficiency related diffuse goiter

  • Endemic goiter

E01.1 - Iodine-deficiency related multinodular goiter

Thyrotoxicosis (Hyperthyroidism)

E05.00 - Thyrotoxicosis with diffuse goiter without thyrotoxic crisis or storm

  • Graves’ disease
  • Basedow’s disease

E05.10 - Thyrotoxicosis with toxic single thyroid nodule without thyrotoxic crisis or storm

  • Plummer’s disease

E05.20 - Thyrotoxicosis with toxic multinodular goiter without thyrotoxic crisis or storm

Other Indications

E07.89 - Other specified disorders of thyroid

  • Large goiter with compressive symptoms
  • Retrosternal goiter

Code Tree / CPT Hierarchy

Surgery (10000-69990)
└── Endocrine System (60000-60699)
└── Thyroid Gland (60200-60300)
├── Excision Procedures (60200-60271)
│ ├── 60200 - Biopsy of thyroid
│ ├── 60210 - Partial thyroid lobectomy, unilateral
│ ├── 60220 - Total thyroid lobectomy, unilateral
│ ├── 60225 - Contralateral subtotal lobectomy
│ ├── 60240 - Thyroidectomy, total or complete ← THIS CODE
│ ├── 60252 - Thyroidectomy with limited neck dissection
│ ├── 60254 - Thyroidectomy with radical neck dissection
│ ├── 60260 - Completion thyroidectomy
│ └── 60270-60271 - Thyroidectomy for malignancy with lymph node dissection
└── Other Procedures (60500-60699)

Lesser Procedures

  • 60220 - Total thyroid lobectomy, unilateral; with or without isthmusectomy
  • 60225 - Total thyroid lobectomy, unilateral; with contralateral subtotal lobectomy

More Extensive Procedures

  • 60252 - Thyroidectomy, total or subtotal for malignancy; with limited neck dissection
    • Includes removal of lymph nodes in central compartment (Level VI)
  • 60254 - Thyroidectomy, total or subtotal for malignancy; with radical neck dissection
    • Includes comprehensive lymph node dissection (Levels I-V)
  • 60260 - Completion thyroidectomy (removal of remaining lobe after previous partial thyroidectomy)

Adjacent Procedures

  • 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
  • 60512 - Parathyroid autotransplantation

Modifiers

Commonly Used Modifiers

Modifier 22 - Increased Procedural Services

  • Use when the work required is substantially greater than typically required
  • Examples:
    • Extremely large goiter (>200 grams)
    • Severe scarring from previous neck surgery or radiation
    • Invasive thyroid cancer requiring extensive dissection
    • Retrosternal extension requiring sternotomy
  • Documentation must support additional work and time

Modifier 50 - Bilateral Procedure

  • NOT applicable to 60240 as total thyroidectomy is inherently bilateral

Modifier 52 - Reduced Services

  • Use when procedure is partially reduced or eliminated at physician discretion
  • Example: Conversion from total to subtotal thyroidectomy due to bleeding or nerve injury risk

Modifier 59 - Distinct Procedural Service

  • Use to indicate separate and distinct procedures performed during same session
  • Examples:
    • Parathyroidectomy (60500) with total thyroidectomy (60240)
    • Intraoperative nerve monitoring (64590) when separately reportable

Modifier 62 - Two Surgeons

  • Use when two surgeons work together as primary surgeons performing distinct parts of the procedure
  • Example: ENT surgeon and general surgeon performing different components
  • Both surgeons must document their distinct portions

Modifier 76 - Repeat Procedure by Same Physician

  • Use when same procedure is repeated subsequent to original procedure
  • Example: Return to OR for completion of thyroidectomy due to bleeding

Modifier 78 - Unplanned Return to OR

  • Use for unplanned return to operating room for related procedure during postoperative period
  • Example: Return to OR for hematoma evacuation or bleeding control

Modifier 79 - Unrelated Procedure by Same Physician

  • Use for unrelated procedure performed during postoperative period
  • Example: Unrelated procedure performed within 90-day global period

Modifier 80 - Assistant Surgeon

  • CPT 60240 allows assistant surgeon
  • Assistant surgeon actively assists primary surgeon throughout procedure
  • Must be medically necessary and documented

Modifier 81 - Minimum Assistant Surgeon

  • Use when assistant surgeon provides minimum assistance

Modifier 82 - Assistant Surgeon (qualified resident unavailable)

  • Use in teaching hospitals when qualified resident not available

RVU Information (2025-2026)

Work RVU (wRVU): 15.04

The work RVU reflects the physician work involved in performing a total thyroidectomy, including:

  • Preoperative evaluation and planning
  • Intraoperative work (typical time: 2-4 hours)
  • Postoperative management during 90-day global period
  • Technical skill and physical effort required
  • Mental effort and judgment
  • Stress related to risk to patient

Practice Expense RVU: Included in total

Malpractice RVU: Included in total

Total RVU

  • Facility Setting: 27.46 RVUs
  • Non-Facility Setting: 27.46 RVUs
  • 2026 Conversion Factor: $33.57 (estimated)
  • Estimated Medicare Payment: $921.50 (facility setting)

Note: Actual payment varies by geographic location due to Geographic Practice Cost Indices (GPCI) adjustments.

Global Period

90-Day Global Surgery Period

CPT 60240 has a 90-day global period, which means:

Included in Global Package (cannot bill separately):

  • Day of Surgery: All services provided on the day of surgery
  • Preoperative Care: One day before surgery (for 90-day global)
  • Postoperative Care: 90 days following surgery including:
    • Routine postoperative visits
    • Wound checks and dressing changes
    • Suture/staple removal
    • Management of typical postoperative pain
    • Treatment of uncomplicated postoperative conditions
    • Standard follow-up laryngoscopy if performed

NOT Included (may bill separately):

  • Initial Consultation: Preoperative visit where decision for surgery is made
  • Diagnostic Tests: Preoperative labs, imaging, EKG
  • Unrelated E/M Services: Treatment of conditions unrelated to thyroidectomy
  • Complications Requiring OR Return: Use modifier 78
  • Unrelated Procedures: Use modifier 79
  • Diagnostic Laryngoscopy: If performed for unrelated reasons

Assistant Surgeon Guidelines

Assistant Surgeon: PAYABLE

CPT 60240 allows payment for assistant surgeon services when medically necessary.

When Assistant Surgeon is Medically Necessary:

  • Large goiter requiring extensive dissection
  • Invasive malignancy with surrounding tissue involvement
  • Reoperative surgery with significant scarring
  • Patient comorbidities requiring additional assistance
  • Teaching hospital requirements

Documentation Requirements:

  • Medical necessity must be documented in operative report
  • Assistant surgeon must dictate separate operative report
  • Both surgeons must maintain separate medical records

Reimbursement:

  • Assistant surgeon typically receives 16% of primary surgeon fee
  • Medicare pays 16% of physician fee schedule amount
  • Commercial payers may vary (typically 10-20%)

Modifiers:

  • 80 - Assistant Surgeon (most common)
  • 81 - Minimum Assistant Surgeon
  • 82 - Assistant Surgeon (qualified resident unavailable)

MS-DRG Assignment

Inpatient Setting: Total thyroidectomy is typically performed as an outpatient procedure. When performed inpatient, MS-DRG assignment depends on:

Possible MS-DRGs (if inpatient):

  • MS-DRG 282-284: Thyroid, Parathyroid and Thyroglossal Procedures
    • 282: With MCC (Major Complication/Comorbidity)
    • 283: With CC (Complication/Comorbidity)
    • 284: Without CC/MCC

Common Inpatient Indications:

  • Large substernal goiter
  • Invasive thyroid cancer
  • Significant comorbidities requiring monitoring
  • Complications requiring extended stay

Note: Most total thyroidectomies are performed in outpatient hospital or ambulatory surgery center settings.

HCC Risk Adjustment

Hierarchical Condition Category (HCC) Impact:

CPT 60240 itself does not directly impact HCC risk adjustment. However, the diagnosis codes reported with the procedure may contribute to HCC assignment:

  • C73 (Thyroid Cancer): Maps to HCC category for malignant neoplasms
    • Contributes to risk adjustment in Medicare Advantage and ACA plans
  • E05.xx (Thyrotoxicosis): May map to HCC categories for endocrine disorders
    • Severity and complications affect HCC assignment

Documentation for HCC:

  • Document all comorbid conditions
  • Specify cancer type and stage when applicable
  • Document severity of thyroid disease
  • Capture all chronic conditions for accurate RAF score

OPPS/ASC Payment

Outpatient Prospective Payment System (OPPS)

APC Assignment: APC 5361 - Level 1 Laparoscopy and Related Services (2025)

Status Indicator: J1 - Hospital Part B services paid through a comprehensive APC

Payment Considerations:

  • Packaged payment under Comprehensive APC
  • Payment includes all services provided during encounter
  • Separate payment may be made for certain high-cost devices or drugs

ASC Payment:

  • Covered in Ambulatory Surgery Center setting
  • Payment based on ASC fee schedule
  • Patient cost-sharing applies

NCCI Edits and Bundling

National Correct Coding Initiative (NCCI) Edits:

CPT 60240 is subject to NCCI edits. Key bundling considerations:

Bundled Services (cannot bill separately):

  • 31500-31579 - Laryngoscopy (unless diagnostic and separate indication)
  • 60500 - Parathyroid exploration (unless parathyroidectomy performed)
  • 88300-88309 - Level I surgical pathology (included in global)
  • 76998 - Ultrasound guidance (unless separately reportable)

Unbundling Examples (may bill with modifier):

  • 60500 - Parathyroidectomy (distinct procedure)
  • 60512 - Parathyroid autotransplantation
  • 64590 - Intraoperative nerve monitoring
  • 88331 - Frozen section pathology
  • 88332-88333 - Permanent section pathology

Modifier 59 Usage:

Use modifier 59 only when no more specific modifier is appropriate and procedures are:

  • Performed at different anatomic sites
  • Performed at separate patient encounters on same day
  • Distinct and separate from the primary procedure

Coding Examples

Example 1: Total Thyroidectomy for Papillary Carcinoma

Clinical Scenario: 45-year-old female with 2.5 cm papillary thyroid carcinoma in right lobe diagnosed by FNA biopsy. Patient undergoes total thyroidectomy without lymph node dissection.

Codes:

  • CPT: 60240 - Thyroidectomy, total or complete
  • ICD-10: C73 - Malignant neoplasm of thyroid gland

Documentation Elements:

  • Preoperative diagnosis: Papillary thyroid carcinoma
  • Procedure: Total thyroidectomy
  • Findings: 2.5 cm nodule in right lobe, no gross extrathyroidal extension
  • Recurrent laryngeal nerves identified and preserved bilaterally
  • All four parathyroid glands identified and preserved
  • Specimen sent for permanent pathology

Example 2: Total Thyroidectomy for Graves’ Disease

Clinical Scenario: 32-year-old female with Graves’ disease unresponsive to medical management. Undergoes total thyroidectomy for hyperthyroidism.

Codes:

  • CPT: 60240 - Thyroidectomy, total or complete
  • ICD-10: E05.00 - Thyrotoxicosis with diffuse goiter without thyrotoxic crisis

Documentation Elements:

  • Preoperative diagnosis: Graves’ disease, hyperthyroidism
  • Indication: Failed medical management, patient preference
  • Procedure: Total thyroidectomy
  • Findings: Diffusely enlarged thyroid, approximately 60 grams
  • Nerves and parathyroids preserved

Example 3: Total Thyroidectomy with Assistant Surgeon

Clinical Scenario: 68-year-old male with large multinodular goiter (150 grams) causing compressive symptoms. Assistant surgeon required due to size and retrosternal extension.

Codes:

  • CPT: 60240 - Thyroidectomy, total or complete
  • Modifier: 80 - Assistant Surgeon (for assistant surgeon’s claim)
  • ICD-10: E04.0 - Nontoxic diffuse goiter

Primary Surgeon Billing:

  • 60240 (no modifier)

Assistant Surgeon Billing:

  • 60240-80

Documentation Elements:

  • Medical necessity for assistant: Large goiter (150g), retrosternal extension
  • Both surgeons’ operative reports
  • Assistant’s specific contributions documented

Example 4: Total Thyroidectomy with Parathyroid Autotransplantation

Clinical Scenario: 55-year-old female with medullary thyroid carcinoma. During total thyroidectomy, one parathyroid gland found devascularized and autotransplanted to sternocleidomastoid muscle.

Codes:

  • CPT: 60240 - Thyroidectomy, total or complete
  • CPT: 60512 - Parathyroid autotransplantation
  • Modifier: 59 - Distinct procedural service (on 60512)
  • ICD-10: C73 - Malignant neoplasm of thyroid gland

Documentation Elements:

  • Four parathyroid glands identified
  • Right inferior parathyroid devascularized during cancer resection
  • Autotransplantation performed to SCM muscle
  • Three parathyroids left in situ with intact blood supply

Example 5: Completion Thyroidectomy (NOT 60240)

Clinical Scenario: Patient had right thyroid lobectomy 6 weeks ago for follicular neoplasm. Final pathology showed papillary carcinoma. Returns for completion thyroidectomy.

Codes:

  • CPT: 60260 - Completion thyroidectomy (NOT 60240)
  • ICD-10: C73 - Malignant neoplasm of thyroid gland

Important: Use 60260, not 60240, when removing remaining lobe after previous lobectomy.

Documentation Requirements

Preoperative Documentation:

  • Indication for surgery
  • Informed consent including risks (bleeding, infection, nerve injury, hypocalcemia)
  • Preoperative laryngoscopy if voice changes
  • Thyroid function tests
  • Imaging studies (ultrasound, CT if indicated)
  • FNA biopsy results if malignancy suspected

Operative Report Must Include:

  1. Preoperative and Postoperative Diagnosis
  2. Procedure Performed: Total thyroidectomy
  3. Indications: Why total vs. lobectomy
  4. Detailed Operative Technique:
    • Type of incision
    • Extent of dissection
    • Management of superior and inferior poles
    • Identification of recurrent laryngeal nerves (bilateral)
    • Identification and preservation of parathyroid glands (number and location)
    • Hemostasis achieved
    • Closure technique
  5. Findings:
    • Thyroid size (grams if estimated)
    • Nodule size and location
    • Extrathyroidal extension if present
    • Lymphadenopathy if present
  6. Specimens: Thyroid gland sent to pathology
  7. Complications: Any intraoperative complications
  8. Estimated Blood Loss
  9. Surgeon and Assistant (if applicable)

Postoperative Documentation:

  • Immediate postoperative course
  • Voice assessment
  • Calcium levels if indicated
  • Drain management if placed
  • Discharge instructions
  • Follow-up plan

Common Coding Errors

Error 1: Using 60240 for Completion Thyroidectomy

Incorrect: 60240 for removal of remaining lobe after previous lobectomy
Correct: 60260 - Completion thyroidectomy

Error 2: Billing Parathyroid Exploration Separately

Incorrect: 60240 + 60500 when parathyroids simply identified and preserved
Correct: 60240 only (parathyroid identification is included)

Error 3: Missing Assistant Surgeon Modifier

Incorrect: Both surgeons bill 60240 without modifiers
Correct: Primary bills 60240, assistant bills 60240-80

Error 4: Incorrect Use of Modifier 50

Incorrect: 60240-50 (bilateral modifier)
Correct: 60240 alone (total thyroidectomy is inherently bilateral)

Error 5: Billing Laryngoscopy During Global Period

Incorrect: 31505 for routine postoperative laryngoscopy
Correct: Included in global package (unless unrelated indication)

Error 6: Undercoding Large Goiters

Incorrect: 60240 for extremely large goiter without modifier
Correct: 60240-22 with documentation of increased work

Clinical Pearls

Indications for Total Thyroidectomy:

  • Thyroid cancer (papillary, follicular, medullary, anaplastic)
  • Bilateral benign disease
  • Graves’ disease unresponsive to medical management
  • Large goiter with compressive symptoms
  • Retrosternal goiter
  • Patient preference (avoiding completion surgery if cancer found)

Contraindications:

  • Uncorrected coagulopathy
  • Severe cardiopulmonary disease precluding anesthesia
  • Patient refusal

Potential Complications:

  • Recurrent Laryngeal Nerve Injury: Temporary (1-5%) or permanent (1-2%)
  • Hypoparathyroidism: Temporary (10-30%) or permanent (1-3%)
  • Hematoma: 1-2% (surgical emergency)
  • Infection: <1%
  • Seroma: 2-5%
  • Thyroid Storm: Rare with proper preoperative preparation
  • Wound Complications: Hypertrophic scar, keloid

Postoperative Care:

  • Monitor calcium levels (q6h initially)
  • Assess voice changes
  • Watch for neck swelling/hematoma
  • Thyroid hormone replacement (levothyroxine)
  • TSH suppression if malignancy
  • Follow-up at 1-2 weeks, then as indicated

Billing Tips

For Professional Services:

  1. Verify assistant surgeon is allowed for patient’s insurance
  2. Document medical necessity for assistant if used
  3. Use appropriate modifiers for unusual circumstances
  4. Capture all diagnosis codes for HCC risk adjustment
  5. Document complexity factors for potential modifier 22

For Facility Services:

  1. Ensure correct APC assignment
  2. Document supply costs for high-cost items
  3. Capture all procedures performed during encounter
  4. Verify medical necessity for inpatient vs. outpatient status

Preauthorization:

  • Most payers require preauthorization for thyroidectomy
  • Submit operative indication and supporting documentation
  • Include imaging and biopsy results
  • Verify in-network facility and surgeon

Quality Measures

Potential Quality Metrics:

  • Recurrent Laryngeal Nerve Injury Rate: Should be <2% permanent
  • Hypoparathyroidism Rate: Should be <3% permanent
  • Return to OR for Bleeding: Should be <2%
  • Surgical Site Infection: Should be <1%
  • Unplanned Readmission: Should be <5%

Documentation for Quality:

  • Document nerve monitoring use if applicable
  • Document number of parathyroids preserved
  • Document calcium levels postoperatively
  • Document voice assessment pre and post-op

References and Resources

Official Sources:

  • AMA CPT Professional Edition
  • CMS Physician Fee Schedule
  • NCCI Policy Manual
  • ICD-10-CM Official Guidelines

Professional Organizations:

  • American Thyroid Association (ATA)
  • American Association of Endocrine Surgeons (AAES)
  • American College of Surgeons (ACS)
  • American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)

Coding Resources:

  • AAPC Coding Guidelines
  • AHIMA Coding Clinic
  • Specialty-specific coding newsletters

Quick Reference Card

**CPT:** 60240  
**Description:** Thyroidectomy, total or complete  
**Global Period:** 90 days  
**wRVU:** 15.04  
**Assistant Surgeon:** Allowed (modifier 80)  
**Common ICD-10:** C73, D34, E05.00, E04.0  
**Key Modifiers:** 22, 59, 62, 80  
**APC:** 5361  
**Bundled:** Parathyroid identification, nerve identification, laryngoscopy (routine)  
**Separate:** Parathyroidectomy (60500), autotransplant (60512), nerve monitoring (64590)

**DO NOT USE FOR:**
- Completion thyroidectomy (use 60260)
- Lobectomy (use 60220)
- Thyroidectomy with neck dissection (use 60252, 60254)

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