# Abnormal TSH dx code



## kcaskey03 (Nov 11, 2011)

I have a question on how to correctly diagnosis an abnormal TSH level. EX: we order a GHP and if the TSH comes back abnormal we then order a Free T4 , what would we use for the Free T-4  (the patient does not have hyper or hypo thyroidism or the GHP dx would not qualify for the Free T4 dx ) .    I've been looking at 790.99 or V77.0 ;  I've read other posts that were related this question and they suggested 790.6 saying its part of a blood chemistry-which i think is incorrect because the ICD 9 book states the blood chemistry levels, and 794.5 / 794.6 is  for function studies.  Can  I get other peoples' input?  Thank you very much in advance!


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## btadlock1 (Nov 11, 2011)

kcaskey03 said:


> I have a question on how to correctly diagnosis an abnormal TSH level. EX: we order a GHP and if the TSH comes back abnormal we then order a Free T4 , what would we use for the Free T-4  (the patient does not have hyper or hypo thyroidism or the GHP dx would not qualify for the Free T4 dx ) .    I've been looking at 790.99 or V77.0 ;  I've read other posts that were related this question and they suggested 790.6 saying its part of a blood chemistry-which i think is incorrect because the ICD 9 book states the blood chemistry levels, and 794.5 / 794.6 is  for function studies.  Can  I get other peoples' input?  Thank you very much in advance!



I agree with 790.99, if the second test comes back 'inconclusive' or 'normal' - don't use a V-code - it will deny for medical necessity. It's a problem, so it should have a problem-oriented diagnosis associated with it. I also agree with you on not using 794.5/794.6 - those are specifically for function studies, and this doesn't really fit.

If the second test comes back abnormal again, I'd suggest looking at 259.9.


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## mitchellde (Nov 11, 2011)

btadlock1 said:


> I agree with 790.99, if the second test comes back 'inconclusive' or 'normal' - don't use a V-code - it will deny for medical necessity. It's a problem, so it should have a problem-oriented diagnosis associated with it. I also agree with you on not using 794.5/794.6 - those are specifically for function studies, and this doesn't really fit.
> 
> If the second test comes back abnormal again, I'd suggest looking at 259.9.



Remember a oder cannot render a dx so you have to look at what the provider states.  We cannot code based on the lab result. If theprovider does not document abnormal result then we cannot code even that.  And we cannot code an endocrine disorder based on an abnormal result.  We must look to the provider to provide us a dx.


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## btadlock1 (Nov 11, 2011)

mitchellde said:


> Remember a oder cannot render a dx so you have to look at what the provider states.  We cannot code based on the lab result. If theprovider does not document abnormal result then we cannot code even that.  And we cannot code an endocrine disorder based on an abnormal result.  We must look to the provider to provide us a dx.



Yes - I should have been more clear about that - I didn't mean "try to interpret the lab results" - but if the provider documents an abnormal result or some other definitive diagnosis of abnormal TSH levels after the labs have come back, you are allowed to code based on the new diagnostic information, in order to report the most accurate diagnosis possible. You should verify any code selection with the provider that you are unsure of, or ask for clarification if the diagnosis isn't apparent, or if you're unable to select a code, based on the docmentation available.


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## kcaskey03 (Nov 14, 2011)

Thank you for the help! I should have mentioned that the provider does note the abnormality of the TSH and then orders more thyroid tests....   Thank you!!


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