CAM 135

Thyroid Disease Testing

Category:Laboratory   Last Reviewed:April 2019
Department(s):Medical Affairs   Next Review:April 2020
Original Date:January 2016    

Description
Thyroid hormones are necessary for prenatal and postnatal development, as well as metabolic activity in adults (Brent, 2017).

Thyroid disease includes conditions which cause hypothyroidism, hyperthyroidism, goiter, thyroiditis (which can present as either hypo- or hyper-thyroidism) and thyroid tumors (Rugge, Bougatsos, & Chou, 2015). 

Thyroid function tests are used in a variety of clinical settings to assess thyroid function, monitor treatment, and screen asymptomatic populations for subclinical or otherwise undiagnosed thyroid dysfunction (D Ross, 2017b). 

The thyroid gland through production of thyroid hormones regulates metabolic homeostasis. Thyroid disease is estimated to occur in approximately 20 million Americans, much of which is undiagnosed (Rugge et al., 2015). The thyroid gland is regulated by TSH, which is secreted by the anterior pituitary which stimulates secretion of two hormones, thyroxine (T4) and triiodothyronine (T3).

Thyroid hormones must be maintained within a carefully regulated range, with adverse clinical consequences at hyperthyroid or hypothyroid extremes. Hypothyroidism is the undersecretion of T4 and T3 resulting in symptoms including fatigue, feeling cold, weight gain, hair loss, poor concentration, dry skin, and constipation. Newborns with undetected or untreated hypothyroidism will have both mental and physical developmental delay. Hypothyroidism during pregnany increases the risk for miscarriage, preterm delivery and pre-eclampsia (Alexander et al., 2017). Hyperthyroidism is the oversecretion of T4 and T3 resulting in symptoms of include palpitations, heat intolerance and sweating, weight loss, hyperactivity, and fatigue. Because a number of these symptoms are so common and nonspecific, they may be subtle and unrecognized (D Ross, 2017a).

Current assays for TSH are extremely sensitive at detecting changes in thyroid homeostasis prior to changes in T4 and T3 levels. TSH is most commonly used as an initial test for thyroid function. In general if the serum TSH is normal, no further testing is needed, however if serum TSH is high, free T4 is used to determine the degree of hypothyroidism, whereas if serum TSH is low free T4 and T3 are used to determine the degree of hyperthyroidism(D Ross, 2017b). Measurement of free T4 is regarded as a better indicator of thyroid function than total T4 measurement for most situations, as it reflects the amount of available, or active, hormone. However, in pregnant patients, measurement of total T4 is recommended due to significant changes in serum proteins during pregnancy, and lack of trimester-specific free T4 reference ranges. Subclinical thyroid dysfunction is defined as an elevated or low TSH test in the setting of normal thyroid hormone levels (Taylor, Razvi, Pearce, & Dayan, 2013). Presently there is considerable controversy as to the appropriate upper limit of normal for serum TSH, and furthermore over the cost effectiveness of screening asymptomatic patients (D Ross, 2017b).

Thyroiditis may be the result of an autoimmune disorder, an infection, or exposure to certain drugs or toxic chemicals which can be either acute or chronic. In the postpartum period, 5-9 percent of women experience thyroiditis, typically as a transient condition(Alexander et al., 2017).

The evaluation of possible autoimmune thyroid disorders includes testing for the presence of thryroid antibodies. Several antibodies against thyroid antigens have been described in chronic autoimmune thyroiditis. The antigens include: thyroglobulin (Tg), thyroid peroxidase (TPO) and the thyrotropin receptor (TRAb). Nearly all patients with Hashimoto's thyroiditis have high serum concentrations of antibodies to Tg and TPO. Thyrotropin receptor antibodies (TRAb) can been classified as stimulating, blocking, or neutral. Stimulating TRAb antibodies cause Graves' disease, however both blocking and stimulating antibodies can be seen in patients with Graves' disease(D Ross, 2017b).

Policy  

  1. Thyroid function testing is considered MEDICALLY NECESSARY in the following situations:
    • Individuals with symptoms consistent with hypothyroidism (See Policy Guidelines)
      • TSH to confirm or rule out primary hypothyroidism.
      • Free T4 as a follow up to abnormal TSH findings
      • Free T4 as a follow-up in cases of suspected secondary hypothyroidism when TSH is normal
      • TSH to distinguish between primary and secondary hypothyroidism.
      • TSH, free T4 for monitoring individuals being treated for hypothyroidism every 6-12 weeks upon dosage change and annually in stable individuals.
    • Individuals with symptoms consistent with hyperthyroidism (See Policy Guidelines)
      • TSH to confirm or rule out primary hyperthyroidism.
      • Free T4 as a follow-up to abnormal TSH findings
      • Total or free T3 as a follow-up to abnormal FT4 findings or if still concerned with hyperthyroidism
      • Free T4 to distinguish between primary and secondary hyperthyroidism.
      • TSH and free T4 should be measured for monitoring individuals being treated for hyperthyroidism every 6-12 weeks
      • Monitoring individuals closely after treatment for hyperthyroidism
        1. Close monitoring first 3 months post-treatment.
        2. Annual monitoring after first year even if asymptomatic for risk of relapse or late-onset hypothyroidism.
    • Asymptomatic individuals at high risk for thyroid disease due to:
      • A personal or family history of thyroid dysfunction (limited to one time)
      • Personal or family history of type 1 diabetes or other autoimmune disorder (limited to one time)
      • Prescribed drugs that can interfere with thyroid function (annually or when dosage or medication changes). Drugs interfering with thyroid function include, but are not limited to: 
        1. Amiodarone, interferon, iodine, lithium, tyrosine kinase inhibitors, sulfonamides.
    • Women undergoing evaluation for infertility
    • Women in pregnancy and postpartum
      • Monitoring of pregnant women being treated for hypothyroidism, every 4 weeks
      • T4 testing for management of thyroid disease during pregnancy
      • FT4 measurements in all patients in 1st trimester in the presence of a suppressed serum TSH.
      • Measurement of serum total T3 (TT3) and thyrotropin receptor antibodies (TRAb) for establishing a diagnosis of hyperthyroidism.
      • TSH testing if there is a thyroid nodule
      • TSH to evaluate first year hypothyroidism
      • TSH in euthyroid, but TPO or Tg antibody positive pregnant women
      • Serum TSH in early pregnancy if 
        1. History of thyroid dysfunction or prior thyroid surgery
        2. Age >30 years
        3. Symptoms of thyroid dysfunction or the presence of goiter
        4. TPOAb positivity
        5. Type 1 diabetes or other autoimmune disorders
        6. History of miscarriage or preterm delivery
        7. History of head or neck radiation
        8. Family history of thyroid dysfunction
        9. Morbid obesity (BMI ≥40 kg/m2)
        10. Use of amiodarone or lithium, or recent administration of iodinated radiologic contrast
        11. Infertility
        12. Residing in an area of known moderate to severe iodine insufficiency
        13. TSH, FT4, and TPOAb tests in postpartum depression
    • Patients with disease or neoplasm of the thyroid or other endocrine glands.
  2. Testing for thyroid antibodies is considered MEDICALLY NECESSARY for the evaluation of autoimmune thyroiditis.
  3. Testing for serum thyroglobulin and anti-thyroglobulin antibody levels is considered MEDICALLY NECESSARY for individuals with thyroid cancer.
  4. Testing for thyrotropin-releasing hormone (TRH) is considered MEDICALLY NECESSARY for the evaluation of the cause of hyperthyroidism or hypothyroidism.
  5. Testing of Reverse T3, T3 uptake and total T4 is considered NOT MEDICALLY NECESSARY in all situations.  
  6. Measurement of total T3 and/or free T3 is considered NOT MEDICALLY NECESSARY in the assessment of hypothyroidism
  7. Measurement of a total or free T3 level is considered NOT MEDICALLY NECESSARY when assessing levothyroxine (T4) dose in hypothyroid patients.
  8. Testing for thyroid dysfunction in asymptomatic nonpregnant individuals for thyroid disease is NOT MEDICALLY NECESSARY during general exam without abnormal finding.

Policy Guidelines 

Hypothyroidism signs and symptoms may include:

  1. Fatigue
  2. Increased sensitivity to cold
  3. Constipation
  4. Dry skin
  5. Unexplained weight gain
  6. Puffy face
  7. Hoarseness
  8. Muscle weakness
  9. Elevated blood cholesterol level
  10. Muscle aches, tenderness and stiffness
  11. Pain, stiffness or swelling in your joints
  12. Heavier than normal or irregular menstrual periods
  13. Thinning hair
  14. Slowed heart rate
  15. Depression
  16. Impaired memory

Hyperthyroidism signs and symptoms may include: 

Hyperthyroidism can mimic other health problems, which may make it difficult for your doctor to diagnose. It can also cause a wide variety of signs and symptoms, including:

  1. Sudden weight loss, even when your appetite and the amount and type of food you eat remain the same or even increase

Rationale 

2015 U.S. Preventive Services Task Force 

The U.S. Preventive Services Task Force indicates that "current evidence is insufficient to assess the balance of benefits and harms of screening for thyroid dysfunction in non-pregnant, asymptomatic adults "(Rugge et al., 2015). In addition, USPSTF recommends against screening for thyroid cancer in asymptomatic adults (Bibbins-Domingo et al, 2017).  

2015 American College of Obstetricians and Gynecologists 

In 2015, ACOG released a practice bulletin that included the following statements on thyroid testing in pregnancy (ACOG, 2015): 

The following recommendations are based on good and consistent scientific evidence (Level A): 

  • "Universal screening for thyroid disease in pregnancy is not recommended because identification and treatment of maternal subclinical hypothyroidism has not been shown to result in improved neurocognitive function in offspring."
  • "The first-line screening test used to assess thyroid status in patients is measurement of the TSH level."
  • "Levels of TSH and free T4 should be measured to diagnose thyroid disease in pregnancy."
  • "The level of TSH should be monitored in pregnant women being treated for hypothyroidism, and the dose of levothyroxine should be adjusted accordingly."
  • "The level of free T4 should be monitored in pregnant women being treated for hyperthyroidism, and the dose of thioamide should be adjusted accordingly."  

The following recommendations are based primarily on consensus and expert opinion (Level C): 

  • "Routine measurements of thyroid function are not recommended in patients with  hyperemesis gravidarum unless other signs of overt hyperthyroidism are evident."
  • "Indicated testing of thyroid function should be performed in women with a personal history of thyroid disease or symptoms of thyroid disease."  

2012 American Thyroid Association and American Association of Clinical Endocrinologists 

TSH testing is supported by the American Thyroid Association (ATA) and American Association of Clinical Endocrinologists (AACE) for individuals with adrenal insufficiency, alopecia, unexplained anemia, unexplained cardiac dysrhythmia, skin texture changes, congestive heart failure, constipation, dementia, type 1 diabetes, dysmenorrhea, hypercholesterolemia, hypertension, mixed hyperlipidemia, malaise and fatigue, unexplained myopathy, prolonged QT interval, vitiligo, or weight gain (Garber et al., 2012).  

The ATA and AACE also provide recommendations for thyroid antibody testing including (Garber et al., 2012): 

  1. "Anti-thyroid peroxidase antibody (TPOAb) measurements should be considered when evaluating patients with subclinical hypothyroidism."
  2. "TPOAb measurement should be considered when evaluating patients with recurrent miscarriage, with or without infertility."  
  3. "Measurement of TSHRAbs using a sensitive assay should be considered in hypothyroid pregnant patients with a history of Graves’ disease who were treated with radioactive iodine or thyroidectomy prior to pregnancy. This should be initially done either at 20-26 weeks of gestation or during the first trimester and if they are elevated again at 20-26 weeks of gestation."  

2011 American Thyroid Association 

In 2011, the American Thyroid Association (ATA) guidelines for the diagnosis and management of thyroid disease during pregnancy and postpartum states that it does not recommend "universal" TSH or free T4 screening of pregnant women or during the preconception period (Stagnaro-Green et al., 2011). It also included the following recommendations:  

Thyroid Function Tests in Pregnancy: 

  1. Trimester-specific reference ranges for thyrotropin (TSH), as defined in populations with optimal iodine intake, should be applied.
  2. If trimester-specific reference ranges for TSH are not available in the laboratory, the following reference ranges are recommended: first trimester, 0.1–2.5 mIU/L; second trimester, 0.2–3.0 mIU/L; third trimester, 0.3–3.0 mIU/L.
  3. The optimal method to assess serum free thyroxine (FT4) during pregnancy is measurement of thyroxine (T4) in the dialysate or ultrafiltrate of serum samples employing on-line extraction/liquid chromatography/tandem mass spectrometry (LC/MS/MS).
  4. If FT4 measurement by LC/MS/MS is not available, clinicians should use whichever measure or estimate of FT4 is available in their laboratory, being aware of the limitations of each method. Serum TSH is a more accurate indication of thyroid status in pregnancy than any of these alternative methods.
  5. In view of the wide variation in the results of FT4 assays, method-specific and trimester-specific reference ranges of serum FT4 are required.  

Thyrotoxicosis in Pregnancy: 

  1. In the presence of a suppressed serum TSH in the first trimester (TSH <0.1 mIU/L), a history and physical examination are indicated. FT4 measurements should be obtained in all patients. Measurement of serum total T3 (TT3) and thyrotropin receptor antibodies (TRAb) may be helpful in establishing a diagnosis of hyperthyroidism.
  2. If the patient has a past or present history of Graves' disease, a maternal serum determination of receptor antibodies (TRAb) should be obtained at 2024 weeks gestation.  

Thyroid Nodules and Thyroid Cancer: 

  1. The optimal diagnostic strategy for thyroid nodules detected during pregnancy is based on risk stratification. All women should have the following: a complete history and clinical examination, serum TSH testing, and ultrasound of the neck
  2. Thyroid hormone therapy may be considered in pregnant women who have deferred surgery for well-differentiated thyroid carcinoma until postpartum. The goal of LT4 therapy is a serum TSH level of 0.1–1.5 mIU/L.
  3. The preconception TSH goal in women with differentiated thyroid cancer (DTC), which is determined by risk stratification, should be maintained during pregnancy. TSH should be monitored approximately every 4 weeks until 16–20 weeks of gestation and once between 26 and 32 weeks of gestation.

 Postpartum Thyroiditis: 

  1. Women with postpartum depression should have TSH, FT4, and TPOAb tests performed.
  2. Women who are symptomatic with hypothyroidism in PPT should either have their TSH level retested in 4–8 weeks or be started on LT4 (if symptoms are severe, if conception is being attempted, or if the patient desires therapy). Women who are asymptomatic with hypothyroidism in PPT should have their TSH level retested in 4–8 weeks.
  3. Women with a prior history of PPT should have an annual TSH test performed to evaluate for permanent hypothyroidism.

 Thyroid Function Screening in Pregnancy:

  1. There is insufficient evidence to recommend for or against universal TSH screening at the first trimester visit.
  2. Serum TSH values should be obtained early in pregnancy in the following women at high risk for overt hypothyroidism:
    • History of thyroid dysfunction or prior thyroid surgery
    • Age >30 years
    • Symptoms of thyroid dysfunction or the presence of goiter
    • TPOAb positivity
    • Type 1 diabetes or other autoimmune disorders
    • History of miscarriage or preterm delivery
    • History of head or neck radiation
    • Family history of thyroid dysfunction
    • Morbid obesity (BMI ≥40 kg/m2)
    • Use of amiodarone or lithium, or recent administration of iodinated radiologic contrast
    •  Infertility
    • Residing in an area of known moderate to severe iodine insufficiency

The 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease during Pregnancy and the Postpartum published revised guidelines for thyroid function testing during pregnancy (Alexander et al., 2017). Some of the recommendations include:  

  • "In lieu of measuring freeT4, total T4 measurement (with a pregnancy-adjusted reference range), is a highly reliable means of estimating hormone concentration during the last part of pregnancy. Accurate estimation of the free T4 concentrations can also be done by calculating a free thyroxine index."
  • "Euthyroid, but TPO or Tg antibody positive pregnant women should have measurement of serum TSH concentration performed at time of pregnancy confirmation, and every 4 weeks through mid-pregnancy."
  • "Evaluation of serum TSH concentration is recommended for all women seeking care for infertility."
  • "Pregnant women with TSH concentrations >2.5 mU/L should be evaluated for TPO antibody status."
  • "Women with overt and subclinical hypothyroidism (treated or untreated), or those at risk for hypothyroidism (e.g. patients who are euthyroid but TPO or TGAb positive, posthemithyroidectomy, or treated with radioactive iodine) should be monitored with a serum TSH measurement approximately every 4 weeks until mid-gestation, and at least once near 30 weeks gestation."
  •  "When a suppressed serum TSH is detected in the first trimester (TSH less than the reference range), a medical history, physical examination, and measurement of maternal serum Free T4 or total T4 concentrations should be performed. Measurement of TSH receptor antibodies (TRAb), and maternal total T3, may prove helpful in clarifying the etiology of thyrotoxicosis."
  •  "In women being treated with antithyroid drugs in pregnancy, FT4/TT4 and TSH should be monitored approximately every 4 weeks."

American Academy of Family Physicians (AAFP) 

American Academy of Family Physicians have issued following recommendations for practice regarding hyperthyroidism: "The diagnostic workup for hyperthyroidism includes measuring thyroid-stimulating hormone, free thyroxine (T4), and total triiodothyronine (T3) levels to determine the presence and severity of the condition, as well as radioactive iodine uptake and scan of the thyroid gland to determine the cause." The level of this evidence is C which is a consensus, disease-oriented evidence, usual practice, expert opinion, or case series (Kravets, 2016). The AAFP recommends using TSH testing to diagnose primary hypothyroidism (Level C) (Gaitonde et al, 2012).  

Choosing Wisely campaign (accessed 02/23/2018 from http://www.choosingwisely.org/clinician-lists/#keyword=thyroid) 

Choosing Wisely campaign has asked clinical professional societies to develop a top five list of tests routinely performed in clinical practice that might need to be questioned by physicians before ordering them. In the search for thyroid disease testing the following recommendations were identified:

American Academy of Pediatrics-Section on Endocrinology (October 2, 2017):  

"Avoid routinely measuring thyroid function and/or insulin levels in children with obesity."  

"Avoid ordering screening tests looking for chronic illness or an endocrine cause, including CBC, CMP, IGF-1, thyroid tests, and celiac antibodies, in healthy children who are growing at or above the 3rd percentile for height with a normal growth rate (i.e., not crossing percentiles) and with appropriate weight gain."  

American Society for Clinical Pathology (February 3, 2015): 

"Don’t order multiple tests in the initial evaluation of a patient with suspected thyroid disease. Order thyroid-stimulating hormone (TSH), and if abnormal, follow up with additional evaluation or treatment depending on the findings."   

The Endocrine Society (Released October 16, 2013; updated July 17, 2017): 

"Don’t order a total or free T3 level when assessing le vothyroxine (T4) dose in hypothyroid patients."   

Kilberg et al (2018) found that "There is variation in NBS practices for screening for congenital hypothyroidism across the US, and many programs do not adjust the TSH cutoff beyond the first 2 days of life. Samples are processed when received from older infants, often to retest borderline initial results. This approach will miss congenital hypothyroidism in infants with persistent mild TSH elevations. They recommend that all NBS programs provide age-adjusted TSH cutoffs, and suggest developing a standard approach to screening for congenital hypothyroidism in the US."  

Li et al (2017) conducted a preliminary study of 6 healthy adult participants and 11 hormone and nonhormone analytes measured by 37 immunoassays, found that ingesting 10 mg/d of biotin for 1 week was associated with potentially clinically important assay interference in some but not all biotinylated assays studied. Ross (2018) writing for UpToDate recommends that thyroid tests should be repeated at least two days after discontinuation of biotin supplements. 

References  

  1. ACOG. (2015). Practice Bulletin No. 148: Thyroid disease in pregnancy. Obstet Gynecol, 125(4), 996-1005. doi:10.1097/01.aog.0000462945.27539.93
  2. Alexander, E. K., Pearce, E. N., Brent, G. A., Brown, R. S., Chen, H., Dosiou, C., . . . Sullivan, S. (2017). 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum. Thyroid, 27(3), 315-389. doi:10.1089/thy.2016.0457
  3. Brent, G. (2017). Thyroid hormone action. In D. Ross (Ed.), UpToDate. Waltham. MA.
  4. Garber, J. R., Cobin, R. H., Gharib, H., Hennessey, J. V., Klein, I., Mechanick, J. I., . . . Woeber, K. A. (2012). Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract, 18(6), 988-1028. doi:10.4158/ep12280.gl
  5. Kilberg, M. J., Rasooly, I. R., LaFranchi, S. H., Bauer, A. J., & Hawkes, C. P. (2018). Newborn Screening in the US May Miss Mild Persistent Hypothyroidism. J Pediatr, 192, 204-208. doi:10.1016/j.jpeds.2017.09.003
  6. Li, D., Radulescu, A., Shrestha, R. T., Root, M., Karger, A. B., Killeen, A. A., . . . Burmeister, L. A. (2017). Association of Biotin Ingestion With Performance of Hormone and Nonhormone Assays in Healthy Adults. Jama, 318(12), 1150-1160. doi:10.1001/jama.2017.13705
  7. Ross, D. (2017a). Diagnosis of hyperthyroidism - UpToDate. In D. Cooper (Ed.), UpToDate. Waltham. MA.
  8. Ross, D. (2017b). Laboratory assessment of thyroid function. In D. Cooper (Ed.), UpToDate. Waltham. MA.
  9. Ross, D. (2018). Laboratory assessment of thyroid function - UpToDate. In D. Cooper (Ed.), Laboratory assessment of thyroid function. Waltham, MA: UpToDate. Retrieved from https://www.uptodate.com/contents/laboratory-assessment-of-thyroid-function?search=thyroid%20function%20tests&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
  10. Rugge, J. B., Bougatsos, C., & Chou, R. (2015). Screening and treatment of thyroid dysfunction: an evidence review for the U.S. Preventive Services Task Force. Ann Intern Med, 162(1), 35-45. doi:10.7326/m14-1456
  11. Stagnaro-Green, A., Abalovich, M., Alexander, E., Azizi, F., Mestman, J., Negro, R., . . . Wiersinga, W. (2011). Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid, 21(10), 1081-1125. doi:10.1089/thy.2011.0087
  12. Taylor, P. N., Razvi, S., Pearce, S. H., & Dayan, C. M. (2013). Clinical review: A review of the clinical consequences of variation in thyroid function within the reference range. J Clin Endocrinol Metab, 98(9), 3562-3571. doi:10.1210/jc.2013-1315 .

Coding Section 

 

Codes

Number

Description

CPT

80438

Thyrotropin releasing hormone (trh) stimulation panel; 1 hour this panel must include the following: thyroid stimulating hormone (tsh) (84443 x 3)

 

80439

Thyrotropin releasing hormone (trh) stimulation panel; 2 hour this panel must include the following: thyroid stimulating hormone (tsh) (84443 x 4)

 

84432

Assay of thyroglobulin

 

84436

Thyroxine; total

 

84437

Thyroxine; requiring elution (eg, neonatal)

 

84439

Thyroxine; free

 

84442

Thyroxine binding globulin (tbg)

 

84443

Thyroid stimulating hormone (tsh)

 

84445

Thyroid stimulating immune globulins (tsi)

 

84479

Thyroid hormone (T3 or T4) uptake or thyroid hormone binding ratio (thbr)

 

84480

Triiodothyronine (T3), Total

 

84481

Triiodothyronine (T3), Free

 

84482

Triiodothyronine T3

 

86376

Microsomal antibodies (eg, thyroid or liver-kidney), each

 

86800

Thyroglobulin antibody

 

S3620

Newborn metabolic screening panel, includes test kit, postage and the laboratory tests specified by the state for inclusion in this panel (e.g. galactose; hemoglobin electrophoresis; hydroxyprogesterone, 17-d; phenylanine (pku); and thyroxine, total)

ICD-10-CM

C25.4

Malignant neoplasm of endocrine pancreas

 

C74

Malignant neoplasm of adrenal gland

 

C75

Malignant neoplasm of other endocrine glands and related stuctures

 

D13.7

Carcinoma in situ of thyroid and other endocrine glands

 

D35.00, D35.01, D35.02

Benign neoplasm of other and unspecified endocrine glands

 

D44

Neoplasm of unspecified behavior of endocrine glands

 

D49.7

Neoplasm of unspecified behavior of endocrine glands

 

E00.0-E00.9

Congenital iodine-deficiency syndrome

 

E01.0-E01.8

Iodine-deficiency related thyroid disorders and allied conditions

  E03.0-E03.9  Other Hypothyroidism 
  E05.0-E05.9 Hyperthyroidism 
  E06.0-E06.9 

Thyroiditis

  E07.0-E07.9  Other disorders of thyroid 
  E10.21-E10.9  Type 1 diabetes mellitus 
  E20.0-E20.9  Hypoparathyroidism 
  E21.0-E21.5  Hyperparathyroidism and other disorders of parathyroid gland 
  E22.0-E22.9  Hyper/unction of pituitary gland 
  E23.0-E23.7  Hypo/unction and other disorders of the pituitary gland 
  E24.0-E24.9  Cushing's syndrome 
  E25.01-E25.9  Adrenogenital disorders 
  E26.01-E26.9  Hyperaldosteronism 
  E27.0-E27.9  Other disorders of adrenal gland 
  E28.0-E28.9  Ovarian dysfunction 
  E29.0-E29.9 

Testicular dysfunction

  E30.0-E30.9  Disorders of puberty, not elsewhere classified 
  E31.0-E31.9  Polyglandular dysfunction 
  E32.0-E32.9  Diseases of thymus 
  E34.0-E34.9  Other endocrine disorders 
  C73, C79.89  Malignant neoplasm, thyroid 
  D09.3  Carcinoma in situ, thyroid 
  E01.0 - E01.2  Iodine-deficiency goiter 
  E02  Subclinical iodine-deficiency hypothyroidism 
  E04.0 - E04.9  Nontoxic goiter 
  E05.00 - E05.01  Thyrotoxicosis w diffuse goiter (includes Graves Disease) 
  E05.00 - E05.91  Thyrotoxicosis (Hyperthyroidism) 
  E10.21 - E10.9  Type 1 diabetes mellitus 
  E27.0 - E27.1  Other adrenocortical overactivity/insufliciency 
  E27.40 - E27.49  Other and unspecified adrenocortical insufficiency 
  E66.01  Morbid obesity 
  E78.0 - E.78.5  Disorders of lipoprotein metabolism and other lipidemias 
  E89.0  Postprocedural hypothyroidism (Postirradiation hypothyroidism; Postsurgical hypothyroidism) 
  F32.0 - F33.9 

Depression

  F41.1 -F41.9   Other anxiety disorders 
  G25.0  Essential tremor 
  G47.9  Sleep disorder, unspecified 
  I10 Hypertension 
  H81.49
  I45.81  Long QT syndrome 
  I47.0 - 147.9  Paroxysmal tachycardia 
  I49.01- 149.02  Other cardiac arrhythmias 
  I50.20 - 150.9  Congestive heart failure 
  I50.810 Right heart failure, unspecified 
  I50.811  Acute right heart failure 
  I50.812  Chronic right heart failure 
  I50.813  Acute on chronic right heart failure 
  I50.814  Right heart failure due to left heart failure 
  I50..82  Biventricular heart failure 
  I50..83  High output heartfailure 
  I50..84 End stage heartfailure 
  I50..89  Other heart failure 
  K59.00 - K59.09  Constipation 
  K75.0  Nonspecific reactive hepatitis 
 

L50 

Urticaria 
 

L63.0 - L63.9; L64.8 -L64.9; L64.8 - L64.9; L65.2, L65.9 

Alopecia 
  L67.0, L67.8  Hair color and hair shaft abnormalities 
  L80 Vitiligo 
  M25.40  Effusion, unspecified joint 
  M25.60  Stiffness of unspecified joint, not elsewhere classified 
  M62.81  Muscle weakness (generalized) 
  M62.9  Disorder of muscle, unspecified 
  N92.0 - N92.6   Excessive, frequent and irregular menstruation 
  N94.4 - N94.6  Dysmenorrhea 
  N96  Recurrent pregnancy loss 
  N97.0 - N97.9  Female infertility 
  O99.280 - O99.285  Endocrine, nutritional and metabolic diseases complicating pregnancy 
  R00.0  Tachycardia, unspecified 
  R00.1  Bradycardia, unspecified 
  R23.4  Changes in skin texture 
  R25.1  Tremor, unspecified 
  R41.0 -R41.82  Other symptoms and signs involving cognitive functions and awareness 
  R45.0, R45.4  Symptoms and signs involving emotional state 
  R49.0 - R49.9 Dysphonia/hoarseness
  R52 Pain, unspecified
  R53.81, R53.83 Other malaise and fatigue
  R60.0 - R60.9 Edema, not elsewhere classified
  R61 Generalized hyperhidrosis (excessive sweating)
  R63.4 Abnormal weight loss
  R63.5 Abnormal weight gain
  R68.89 Other general symptoms and signs
  R74.8-R74.9 Abnormal level of other serum enzymens
  Z30.0 - Z39.2 Encounter for maternal postpartum care and examination 
  Z31.41  Encounter for fertility testing 
 

Z33.1

Pregnant state, incidental

  Z34.00 - Z34.93  Encounter for supervision of normal pregnancy 
  Z79.3 long term (current) use of hormonal contraceptives
  Z79.810-Z79.818  Long term (current) use of agents affecting estrogen receptors and estrogen levels
  Z79.899  Long term (currrent) use other meds
  Z83.49  Family history of other endocrine, nutritional and metabolic diseases
  Z85.850  Personal hx malignant neoplasm of thyroid
  Z86.39  Personal history of other endocrine, nutritional and metabolic disease

 

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.

This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross and Blue Shield Association technology assessment program (TEC) and other non-affiliated technology evaluation centers, reference to federal regulations, other plan medical policies, and accredited national guidelines.

"Current Procedural Terminology © American Medical Association.  All Rights Reserved" 

History From 2016 Forward     

04/02/2019 

Annual review, adding policy statement:Testing for thyroid dysfunction in asymptomatic nonpregnant individuals for thyroid disease DOES NOT MEET COVERAGE CRITERIA during general exam without abnormal findings. Updating coding. No other changes. 

01/15/2019 

Corrected ICD 10 diagnosis D99.280-D99.285 to O99.280-O99.285. No other changes made. 

01/08/2019 

Correct typo in Coding Section. No other changes. 

10/10/2018 

Updated coding section adding ICD-10-CM. No change to policy intent. 

08/10/2018 

Updated coding section adding ICD-10-CM. No change to policy intent 

08/06/2018 

Reformatting policy for clarity, also removing any medical necessity for total thyroxine testing. 

04/19/2018 

Annual review, removing and/or statement regarding Free T4 testing, updating T3 testing to be not medically necessary from previous investigational status. Coverage criteria 6 and 7 added. No other changes made.

09/28/2017

Updated coding section with 2018 coding. No other changes.

06/28/2017 

Interim review, no change to policy intent. Updating background, description, policy (for clarity), guidelines, rationale and references. 

06/19/2017 

Updated coding section. No other changes made. 

04/25/2017 

Updated category to Laboratory. No other changes

04/17/2017 

Annual review, no change to policy intent. 

01/04/2017 

Annual review, no change to policy intent. 

07/11/2016 

Interim review, updating background, rationale and coding. Adding medical necessity criteria for testing in early pregnancy for members with a history of miscarriage or other preterm delivery. 

04/11/2016 

Interim update, adding additional criteria related to testing in women who are pregnant or post partum.

01/12/2016

NEW POLICY

 


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