(PDF) Thyroid Testing - Quest Diagnostics · results. When a test for total thyroxine (total T4 or T4 radioimmunoassay) ... It may be medically necessary to do follow-up thyroid testing - DOKUMEN.TIPS (2024)

CPT:

Medicare National Coverage Determination Policy

CMS National Coverage Policy

Medically Supportive ICD Codes are listed

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84436, 84439, 84443, 84479

Thyroid Testing

Coverage Indications, Limitations, and/or Medical Necessity

Thyroid function studies are used to delineate the presence or absence of hormonal abnormalities of the thyroid and pituitary glands.

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 sensitive thyroid-

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 may be

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

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

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

consciousness; malaise; hypothermia; symptoms of the nervous and musculoskeletal system; skin and integumentary system; nutrition

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.

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CPT:

Code Description

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

Medicare’s limited coverage policy. If you are ordering this test for diagnostic reasons that are

not covered under Medicare policy, an Advance Beneficiary Notice form is required.

*Note—Bolded 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)

is necessary. Diagnosis codes must be applicable to the patient’s symptoms or conditions and must be consistent with documentation in the

patient’s medical record. Quest Diagnostics does not recommend any diagnosis codes and will only submit diagnosis information 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/MLCP to view current limited coverage tests, reference guides, and policy information.

To view the complete policy and the full list of medically supportive codes, please refer to the CMS website reference Right Click “Hyperlink” to Add CMS URL

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D64.9 Anemia, unspecified

E03.8 Other specified hypothyroidism

E03.9 Hypothyroidism, unspecified

E05.90 Thyrotoxicosis, unspecified without thyrotoxic crisis or storm

E07.9 Disorder of thyroid, unspecified

E11.65 Type 2 diabetes mellitus with hyperglycemia

E11.9 Type 2 diabetes mellitus without complications

E29.1 Testicular hypofunction

E78.00 Pure hypercholesterolemia, unspecified

E78.2 Mixed hyperlipidemia

E78.4 Other hyperlipidemia

E78.5 Hyperlipidemia, unspecified

I10 Essential (primary) hypertension

I48.91 Unspecified atrial fibrillation

R53.1 Weakness

R53.81 Other malaise

R53.82 Chronic fatigue, unspecified

R53.83 Other fatigue

R94.6 Abnormal results of thyroid function studies

Z79.899 Other long term (current) drug therapy

84436, 84439, 84443, 84479

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with this test. Please refer to the

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01/02/18

Thyroid Testing

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