Pathology/Lab Coding Alert

Question: A physician ordered a thyrotropin releasing hormone stimulation panel, anti-thyroperoxidase antibody, and total thyroxine for a hypothyroid patient. How should we code this, and will Medicare cover these tests together based on the diagnosis? New Mexico Subscriber Answer: Whether Medicare will cover the tests you mentioned for a hypothyroid patient will depend partly on the exact diagnosis and what prior testing the patient had (and when). For hypothyroid patients (diagnosis codes 243, Congenital hypothyroidism or 244.x, Acquired hypothyroidism), the National Coverage Determination (NCD) states that tests may be reasonable and necessary to: • Distinguish between primary and secondary hypothyroidism • Confirm or rule out primary hypothyroidism • Monitor thyroid hormone levels • Monitor drug therapy in patients with primary hypothyroidism. Regarding testing frequency, the NCD states, "Testing may be covered up to two times a year in clinically stable patients; more frequent testing may be reasonable and necessary for [...]