Pathology/Lab Coding Alert

Question: Why does our lab sometimes get denials for TSH tests ordered for patients on hormone therapy for hypothyroidism?


Connecticut Subscriber
Answer: The reason for denials could stem from the diagnosis code or the testing frequency for thyroid stimulating hormone (84443, Thyroid stimulating hormone [TSH]).

Hypothyroidism ICD-9 codes are 243 (Congenital hypothyroidism) or 244.x (Acquired hypothyroidism). But if you-re reporting acquired hypothyroidism, you must use a four-digit code. That means you need to know if the condition is due to thyroid removal (244.0, Postsurgical hypothyroidism) or some other specific cause. If you don't have more specific information, you should report 244.9 (Unspecified hypothyroidism) rather than 244.

If the physician orders the test to monitor drug therapy, you should also report V58.69 (Long-term [current] use of other medications).

Medicare limits thyroid function testing to two times a year in clinically stable patients. Although more frequent testing might be covered for patients with altered thyroid therapy or other instability, you could get denials if you don't adequately document the reason.