Otolaryngology Coding Alert

Take note: General rules of coding will remain the same except for some subcategory variations.

The thyroid gland is located in the front part of the neck, and produces the thyroid hormone which vital to normal metabolism. Thyroid disorders range from the thyroid gland becoming overactive (hyperthyroidism, 242 in ICD-9) or underactive (hypothyroidism, 244 in ICD-9).

In ICD-10-CM, disorders of the thyroid gland are classified to categories E00-E07. The categories are as follows:

• E00 -- Congenital iodine-deficiency syndrome;
• E01 -- Iodine-deficiency related thyroid disorders and allied conditions;
• E02 -- Subclinical iodine-deficiency hypothyroidism;
• E03 -- Other hypothyroidism;
• E04 -- Other nontoxic goiter;
• E05 -- Thyrotoxicosis [hyperthyroidism];
• E06 -- Thyroiditis; and
• E07 -- Other disorders of thyroid.

ICD difference: The coding rules related to thyroid diseases will be generally the same in ICD-10-CM as in ICD-9-CM. However, ICD-10-CM will classify some conditions to different chapters or different blocks. For instance, ICD-9-CM's code for postsurgical hypothyroidism is 244.0, which is in the hypothyroidism category. On the other hand, in ICD- 10-CM you will not locate postsurgical hypothyroidism under category E03. Instead, you will code it with E89.0, which is under category E89 (Postprocedural endocrine and metabolic complications and disorders, not elsewhere classified).

Coder tips: The physician sees a patient who recently had surgery and radiation therapy for her thyroid cancer. The physician performs a level-two E/M and diagnoses the patient with hypothyroidism caused by the recent treatments. In this case, you should choose a more specific ICD-9 code than E03.9 (Hypothyroidism, unspecified). When the patient has recently had thyroid surgery or radiation therapy that caused the hypothyroidism, choose the fourth digit based on the most recent factor influencing the hypothyroidism. For instance, if the patient most recently had surgery, report E89.0 (Postprocedural hypothyroidism). If the radiation therapy was more recent, ICD-10-CM guidelines state that you would report the same code (E89.0).