Thyroid Cancer Awareness Month: A personal story

September 14th, 2018 / By Gail Barackman, CPC, CPMA, CEMC

September is Thyroid Cancer Awareness month, so I thought I would share my personal experience with diagnostic studies for Thyroid Cancer. As someone who suffers from Hashimoto’s Hypothyroidism, regular thyroid lab panels and yearly ultrasound studies are a necessity. I have always had benign findings on my ultrasounds, but a few years ago the ultrasound showed an enlarged thyroid nodule. My endocrinologist did not like how the nodule had grown quickly in the year since my previous study, so he felt a biopsy was indicated.

I scheduled what is called a Fine Needle Biopsy or FNA with a local surgeon. During the surgical consultation, the surgeon explained that it was a simple, in-office procedure and did not require anesthesia. A local anesthetic would be used in the area of the biopsy and the biopsies would be performed under ultrasound guidance to assist in locating the nodule. While waiting several weeks for my biopsy appointment, I grew more and more nervous as I read articles about Thyroid Cancer.

Upon arriving for my thyroid biopsy, I was brought to what was no more than an exam room with ultrasound equipment. I was told by the nurse that it only hurts a little, like a pinch when the anesthetic is administered and then pressure when the biopsies are taken. The provider entered the room to administer the anesthetic, and sure enough it was just a “pinch” when he injected the numbing agent. But the biopsy was more than just pressure, it felt like I was being drilled with a drinking straw. I had three biopsies total, which took about 15 minutes, but felt like 15 hours. When it was finally over, I was left with a sensation of being punched in the throat, while having a pit in my stomach over the whole experience.

Next came a two-week wait for the pathology results. The collected nodule cells are sent to a special laboratory for testing by a cytopathologist, who views the cells under a microscope to determine if the cells are benign, malignant or inconclusive. If the results are benign or malignant, the laboratory test is complete and the results are sent back to the surgeon. If the results are inconclusive they are sent for genomic testing to determine the likelihood of the cells being cancerous.

Unfortunately, my results were inconclusive and the additional testing–and waiting–was necessary. Fortunately, in the end the cells were found to be benign. And in the years since, the nodule size has shrunk and I have not had to repeat the biopsy. If I were to have to relive the experience, here are the codes that I would see on my Explanation of Benefits:

Diagnosis code               ICD-10: E04.1       Nontoxic single thyroid nodule

Thyroid Ultrasound:        CPT: 76536          Ultrasound, soft tissues of head and neck

Surgical Consultation:     CPT: 99243          Office consultation for a new/established patient, low complexity, detailed history and exam

Fine Needle Biopsy:        CPT: 10022          Fine needle aspiration; with imaging guidance

Ultrasound for FNA:         CPT: 76942          Ultrasonic guidance for needle placement

Cytopathology:                 CPT: 88173          Cytopathology, evaluation of fine needle aspirate; immediate  

                                                                      cytohistologic study to determine adequacy for diagnosis, first

                                                                      evaluation episode, each site

Genomic assay:                CPT: 81545          Oncology (thyroid), gene expression analysis of 142 genes,

                                                                       utilizing fine needle aspirate, algorithm reported as a

                                                                       categorical result (e.g., benign or suspicious)

It is estimated that 53,990 adults will be diagnosed with Thyroid Cancer in 2018, with an estimate of 2,060 deaths. Although the survivor rate for Thyroid Cancer is high at 98 percent, it is still a disease that may require surgery, radiation therapy, chemotherapy or any combination of these treatments. Though the process can be painful, it is important to follow through with the additional testing if nodules are found on your thyroid.

Gail Barackman is a coding analyst at 3M Health Information Systems.