DRG 627: Thyroid, Parathyroid and Thyroglossal Procedure
Each of the Medicare Severity Diagnosis Related Groups (MS-DRG) is defined by a particular set of patient attributes which include principal diagnosis, specific secondary diagnoses, procedures, sex and discharge status.
DRG 627 is classified as Major Diagnostic Category (MDC) 10 Endocrine, Nutritional & Metabolic Diseases & Disorders.
The thyroid gland is a midline structure located in the anterior neck. The thyroid functions as an endocrine gland and is responsible for producing thyroid hormone and calcitonin, thus contributing to the regulation of metabolism, growth, and serum concentrations of electrolytes such as calcium. Many disease processes can involve the thyroid gland, and alterations in the production of hormones can result in hypothyroidism or hyperthyroidism. The thyroid gland is involved in inflammatory processes (e.g., thyroiditis), autoimmune processes (e.g., Graves disease), and cancers (e.g., papillary thyroid carcinoma, medullary thyroid carcinoma, and follicular carcinoma).
In addition to considering its role in metabolism, growth, regulation of certain electrolytes, and its involvement in many disease processes, the thyroid gland deserves consideration for its anatomical location and its close relationship to important structures including the parathyroid glands, recurrent laryngeal nerves, and certain vasculature.
The parathyroid glands are in close anatomic relationship to the thyroid gland, sitting on the posterior aspect of the thyroid gland. The parathyroid glands also share arterial supply with the thyroid gland, being supplied by an end-artery, typically the inferior thyroid artery. Due to its anatomic relationship and vascular supply, there a few considerations with regards to the parathyroid glands in thyroid surgeries.
Thyroglossal Duct Cyst Procedure
Approximately 50 percent of thyroglossal duct cysts are close to or just inferior to the hyoid bone. Due to its relation to the hyoid bone and the rates of recurrence, surgical removal includes the cyst, the middle segment of the hyoid bone, and the tract that leads to the base of the tongue. This procedure is referred to as the Sistrunk Procedure.
Tips to meet medical necessity of admissions for procedures and surgeries include:
- When patients are admitted for the sole purpose of performing the procedure(s), the inpatient admission will be denied if documentation does not support the need for intense post-operative treatment warranting inpatient admission
- Planned/scheduled procedure(s) not on the CMS Addendum E inpatient-only list can be billed and paid under Outpatient Perspective Payment System (OPPS). These services can be safely rendered in the facility but in an outpatient status.
- Ensure clinical documentation submitted for review supports the medical necessity for procedures billed. The medical record needs to include sufficient pre-surgical findings and associated symptoms (including, but not limited to, preoperative testing, exams, objective as well as subjective criteria, etc.) that support medical necessity of procedure(s) performed on date of service.
- Provide sufficient pre-operative documentation indicating conventional therapy was attempted or why conventional pre-surgical therapy was not done or tolerated is needed to support the medical necessity of these in-patient only procedures.
Procedure codes are available on the CMS website.