Preoperative Diagnosis: Thyroid Goiter

Multiple Choice

Preoperative Diagnosis: Thyroid goiter.
Postoperative Diagnosis: Thyroid goiter.
Procedure Performed: Total thyroidectomy.
Indications: The patient is a 45-year-old female with Graves' disease. Suppression was attempted but unsuccessful. She presents today with her thyroid goiter. A thyroidectomy was indicated at this time secondary to the patient's chronic condition. A full informed consent was obtained.
Procedure: The patient was brought back to surgical suite and given IV access and general endotracheal anesthesia. A 9 cc of 1% lidocaine with 1:100,000 of epinephrine was infiltrated into the area of pre-demarcated above the suprasternal notch. The patient was then prepped and draped in the normal sterile fashion. A #10 blade was then utilized to make an incision in the pre-demarcated and anesthetized area. Unipolar electrocautery was utilized for hemostasis. Finger dissection was carried out in the superior and inferior planes. Platysma was identified and dissected and a subplatysmal plane was created in the superior and inferior, medial and lateral directions. The strap muscles were identified. The midline raphe was not easily identifiable at this time. An incision was made through what appeared to be in the midline raphe and dissection was carried down to the thyroid. Sternohyoid and sternothyroid muscles were identified and separated on the patient's right side and then subsequently on the left side. It was noted at this time that the thyroid lobule on the right side is a bi-lobule. Kitner blunt dissection was utilized to bluntly dissect the overlying thyroid fascia as well as strap muscles off the thyroid, in the lateral direction. This was carried down to the inferior and superior areas. The superior pole of the right lobule was then identified. A hemostat was placed in the cricothyroid groove and the superior pole of the right thyroid was retracted inferiorly. Careful dissection was then carried out in the superior lobe and identified the appropriate vessels and cauterized with bipolar or ligated with the suture ligature. The superior pole was identified. Dissection was then carried down again bluntly separating the inferior and superior lobes. The bilobed right thyroid was then retracted medially. The recurrent laryngeal nerve was then identified and tracked to its insertion. A right dissection was performed to remove the fascial attachments superficial to the recurrent laryngeal nerve. This lobule was then removed from Berry's ligament. There was noted to be no isthmus at this time and the entire right lobule was then sent to pathology for evaluation. Attention was then directed to the patient's left side. In a similar fashion, the sternohyoid and sternothyroid muscles were separated. Blunt dissection was carried out laterally to superiorly once again. A careful dissection was utilized to identify the appropriate structures in the superior pole of the left thyroid and suture ligature as well as bipolar cautery was utilized for hemostasis. Once again, careful attention was made not to injure the nerve in this area. The superior pole was then freed appropriately and blunt dissection was carried down to lateral and inferior aspects. The inferior aspect was then identified. The inferior thyroid artery and vein were then identified and ligated. The left thyroid was then medialized and the recurrent laryngeal nerve was identified. Dissection was then carried out to remove the fascial attachments superficial to the recurrent laryngeal nerve on the side as close to the thyroid gland as possible. The thyroid was then removed from the Berry's ligament and it was then sent to pathology for evaluation. The patient tolerated the procedure well and was transferred to recovery in stable condition.
Select the appropriate CPT and ICD-10-CM codes.

A) 60210, E04.9
B) 60252, E04.9
C) 60252, E05.00
D) 60240, E05.00