Technical review by the Brazilian Society of Surgical Oncology and the Brazilian Society of Head and Neck Surgery on hierarchical coding in thyroid surgery.

The Brazilian Society of Surgical Oncology and the Brazilian Society of Head and Neck Surgery developed a technical consensus on hierarchical coding in thyroid surgery, considering the role of the Brazilian Hierarchical Classification of Medical Procedures in determining appropriate codes. A panel of 40 specialists - recognized academic and clinical leaders from across Brazil - assessed the applicability of procedure codes for common thyroid surgeries and prepared the current consensus. Deliberations were conducted via electronic voting among 37 participants, and consensus was defined as agreement by at least 80%. Scenarios included total thyroidectomy for benign and malignant disease and resection of substernal goiter. The analysis covered codes for laryngeal nerve exploration, neurophysiological monitoring, carotid artery branch ligation, biopsy, parathyroid reimplantation, lymphadenectomy, and neck dissection. Consensus supported the use of the following codes: nerve exploration (83.3%), neurophysiological monitoring (97.3%), biopsy and parathyroid reimplantation (89.2%), cervical lymphadenectomy (89.2%), and unilateral or bilateral neck dissections (97.3% and 94.6%, respectively). No consensus was reached on including carotid artery branch ligation or adding a partial thyroidectomy code for unilateral substernal goiter; therefore, these codes were not validated. The current consensus provides clear, objective guidance on hierarchical coding for thyroid surgery based on technical, scientific, and ethical criteria. It is intended to support attending physicians and auditors by promoting consistency, transparency, and reduced conflict in clinical and administrative settings.