ED Coding and Reimbursement Alert

Question: A patient who recently had surgery and radiation therapy to treat her thyroid cancer reports to the ED complaining of weakness, depression and a lack of tolerance for cold weather. The physician performs a level-four E/M and diagnoses the patient with hypothyroidism caused by the recent treatments. Should I use 244.9 as an ICD-9 code for the hypothyroidism?

Minnesota Subscriber

Answer: You should choose a more specific ICD-9 code than 244.9 (Unspecified hypothyroidism). When coding for this condition, choose a diagnosis that reflects the postsurgical/postradiation state of the condition.

When the patient has recently had thyroid surgery or radiation therapy that caused the hypothyroidism, choose the fourth digit based on the most recent factor influencing the hypothyroidism. If the patient most recently had surgery, report 244.0 (Postsurgical hypothyroidism). If the radiation therapy was more recent, report 244.1 (Other postablative hypothyroidism).

Suppose the patient more recently had thyroid surgery. On the claim, report the following:

- 99284 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: a detailed history; a detailed examination; medical decision-making of moderate complexity) for the E/M

- 193 (Malignant neoplasm of thyroid gland) linked to 99284 to represent the patient's thyroid cancer

- 244.0 linked to 99284 to indicate that the patient had surgery recently.