Radiology Coding Alert

Know when you should report 78014.

Radiology coders will confirm that seldom-used codes can end up being the most troublesome. Thyroid imaging studies can often cause headaches among new and experienced coders alike, but with this review of key terms and code descriptors, you’ll be prepared when a thyroid image report comes across your workflow.

Read on to recognize how to assign the correct thyroid imaging codes.

Get to Know the Thyroid Study Codes

The CPT^® code set features seven codes designated for diagnostic testing related to the thyroid gland. Four of those codes pertain to cancer metastases, but the remaining three are used to evaluate the gland:

• 78012 (Thyroid uptake, single or multiple quantitative measurement(s) (including stimulation, suppression, or discharge, when performed))
• 78013 (Thyroid imaging (including vascular flow, when performed))
• 78014 (Thyroid imaging (including vascular flow, when performed); with single or multiple uptake(s) quantitative measurement(s) (including stimulation, suppression, or discharge, when performed))

A physician uses thyroid uptake to evaluate the thyroid gland’s function. Meanwhile, a physician uses a thyroid scan to assess the gland’s position, size, and shape.

Understand the Thyroid Uptake Procedure

During a thyroid uptake procedure (78012), which is also known as a radioactive iodine uptake test (RAIU), the provider administers a pill containing a small amount of radioiodine to the patient. “This service involves the patient taking an oral dose of radioactive iodine,” details Barry Rosenberg, MD, chief of radiology at United Memorial Medical Center in Batavia, New York. “Imaging using a gamma probe is then performed approximately 24 hours later,” Rosenberg adds.

The radioiodine reaches the patient’s thyroid gland within four to 24 hours after ingestion — during that time, the patient may leave the office before returning to the facility for scanning.

The physician uses a gamma probe or a scintillation detector to image the thyroid gland. The device measures how much radioiodine the thyroid gland absorbs. The physician may require the patient to return multiple times for additional uptake measurements. Additionally, the provider may administer medication before the thyroid uptake procedure to suppress, stimulate, or affect radioiodine discharge from the thyroid.

Identify the Correct Thyroid Imaging Codes

You’ll assign 78013 when the provider performs thyroid imaging to evaluate for possible lumps or inflammation, check for an overactive thyroid, and assess the thyroid’s function, size, and structure. During the exam, the physician administers radioiodine either intravenously (IV) or orally. With an IV injection, the provider will start the scan between 30 and 60 minutes after administering the radioiodine dose.

The provider uses a gamma camera to scan the thyroid from several angles, so they can accurately assess the anatomical structure from multiple images. The provider may also evaluate the blood flow in the thyroid and adjacent nodules to determine if the flow patterns are consistent with benign growths or cancerous ones.

When the provider performs a thyroid scan and thyroid uptake measurements, you’ll assign 78014 for the procedures.

Examine the Following Thyroid Study

Scenario: A patient presented to an outpatient radiology practice for a thyroid study. The radiologist injects radioiodine into the patient’s vein, and 45 minutes later uses a gamma camera to examine the patient’s left thyroid gland, capturing images from multiple angles and compiling them on the computer. The provider also evaluated the vascular flow into and out of the thyroid and the surrounding structures. After the imaging scan, the provider reviewed the images, interpreted the results, and wrote their report. The provider listed the impression as hyperthyroidism.

For this scenario, you’ll assign 78013 to report the procedure. The provider performed a thyroid imaging scan with a vascular flow assessment but did not perform a thyroid uptake measurement.

Next, you’ll turn to the ICD-10-CM code set to locate the diagnosis code for the radiologist’s impression. In the Alphabetic Index, look for Hyperthyroidism (latent) (pre-adult) (recurrent). You’ll then verify the code in the Tabular List. You’ll assign E05.90 (Thyrotoxicosis, unspecified without thyrotoxic crisis or storm) to report the diagnosis.

Parent code E05.9- (Thyrotoxicosis, unspecified) features an additional synonym of Hyperthyroidism NOS, which means not otherwise specified. According to the ICD-10-CM Official Guidelines, section I.A.6.b, the abbreviation NOS “is the equivalent of unspecified.”