[PDF] [PDF] Thyroid Testing - Quest Diagnostics

stimulating hormone (TSH) levels, complemented by determination of thyroid The ICD10 codes listed below are the top diagnosis codes currently utilized by 



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CPT:

Medicare National Coverage Determination Policy

CMS National Coverage Policy

Visit QuestDiagnostics.com/MLCPto view current limited coverage tests, reference guides, and policy information.

To view the complete policy and the full list of codes, please refer to the CMS website reference

84436, 84439, 84443, 84479 Thyroid Testing

Coverage Indications, Limitations, and/or Medical NecessityThyroid function studies are used to delineate the presence or absence of hormonal abnormalities of the thyroid and pituitaryglands.

These abnormalities may be either primary or secondary and often but not always accompany clinically defined signs and symptoms

indicative of thyroid dysfunction.

Laboratory evaluation of thyroid function has become more scientifically defined. Tests can be done with increased specificity, thereby

reducing the number of tests needed to diagnose and follow treatment of most thyroid disease. Measurements of serum sensitivethyroid-

stimulating hormone (TSH) levels, complemented by determination of thyroid hormone levels [free thyroxine (fT-4) or total thyroxine (T4)

with Triiodothyronine (T3) uptake] are used for diagnosis and follow-up of patients with thyroid disorders. Additional tests maybe

necessary to evaluate certain complex diagnostic problems or on hospitalized patients, where many circumstances can skew tests

results. When a test for total thyroxine (total T4 or T4 radioimmunoassay) or T3 uptake is performed, calculation of the freethyroxine

index (FTI) is useful to correct for abnormal results for either total T4 or T3 uptake due to protein binding effects.

Indications

Thyroid function tests are used to define hyper function, euthyroidism, or hypofunction of thyroid disease. Thyroid testing may be

reasonable and necessary to: Distinguish between primary and secondary hypothyroidism

Confirm or rule out primary hypothyroidism

Monitor thyroid hormone levels (for example, patients with goiter, thyroid nodules, or thyroid cancer)

Monitor drug therapy in patients with primary hypothyroidism

Confirm or rule out primary hyperthyroidism

Monitor therapy in patients with hyperthyroidism

Thyroid function testing may be medically necessary in patients with disease or neoplasm of the thyroid and other endocrine glands.

Thyroid function testing may also be medically necessary in patients with metabolic disorders; malnutrition; hyperlipidemia; certain types

of anemia; psychosis and non-psychotic personality disorders; unexplained depression; ophthalmologic disorders; various cardiac

arrhythmias; disorders of menstruation; skin conditions; myalgias; and a wide array of signs and symptoms, including alterations in

c o n s c iou s n e s s m a lais e h y p o t h e r m ia; s y m p t o m s o f t h e n e r v o u s a n d m u s c u los k e let a l s y s t e m s k in a n d int e g u m e n t a r y s y s t e m n u t r ition and metabolism; cardiovascular; and gastrointestinal system.

It may be medically necessary to do follow-up thyroid testing in patients with a history of malignant neoplasm of the endocrine system

and in patients on long-term thyroid drug therapy.

Limitations

Testing may be covered up to two times a year in clinically stable patients; more frequent testing may be reasonable and necessary for

patients whose thyroid therapy has been altered or in whom symptoms or signs of hyperthyroidism or hypothyroidism are noted.

www.cms.gov Ź CPT:

CodeDescription

Medicare National Coverage Determination Policy

The ICD10 codes listed below are the top diagnosis codes currently utilized by ordering physicians for the limited coverage test highlighted above that are also listed as medically supportive under If you are ordering this test for diagnostic reasons that are not covered under Medicare policy, an Advance Beneficiary Notice form is required. *NoteBolded diagnoses below have the highest utilization

Disclaimer:

This diagnosis code reference guide is provided as an aid to physicians and office staff in determining when an ABN (Advance Beneficiary Notice)

ation in the provided

to us by the ordering physician or his/her designated staff. The CPT codes provided are based on AMA guidelines and are for informational

purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.

Last updated:

Visit QuestDiagnostics.com/MLCPto view current limited coverage tests, reference guides, and policy information.

To view the complete policy and the full list of codes, please refer to the CMS website reference

QuestDiagnostics.com

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D64.9Anemia, unspecified

E03.8Otherspecified hypothyroidism

E03.9Hypothyroidism, unspecified

E04.2Nontoxic multinodular goiter

E05.90Thyrotoxicosis, unspecified without thyrotoxic crisis or storm

E06.3Autoimmune thyroiditis

E11.65Type 2 diabetes mellitus with hyperglycemia

E11.69Type 2 diabetes mellitus with other specified complication E11.9Type 2 diabetes mellitus without complications

E78.00Pure hypercholesterolemia, unspecified

E78.2Mixed hyperlipidemia

E78.49Otherhyperlipidemia

E78.5Hyperlipidemia, unspecified

E89.0Postprocedural hypothyroidism

I10Essential (primary) hypertension

R53.82Chronic fatigue, unspecified

R53.83Other fatigue

R73.03Prediabetes

R94.6Abnormal results of thyroid function studies

Z79.899Other long term (current) drug therapy

84436, 84439, 84443, 84479

There is a frequency associated

with this test. Please refer to the

Limitations or Utilization

Guidelines section on previous

page(s).

10/01/22

Thyroid Testing

www.cms.gov Źquotesdbs_dbs17.pdfusesText_23