Home Health ICD-9/ICD-10 Alert

Question: What is the proper way to code a patient who was diagnosed with and treated with radiation for Graves disease but who now manifests hypothyroidism? Do we code both conditions or just one?

Answer: A patient with Graves disease has an overactive thyroid which results in the patient developing both hyperthyroidism and thyrotoxicosis. Because hyperthyroidism is a symptom of this autoimmune disease, you would code for both conditions with one code: 242.0x (Toxic diffuse goiter).

You'll select a fifth digit for this code based on whether your patient has experienced a sudden exacerbation of his hyperthyroidism and onset of new symptoms known as a thyrotoxic crisis of storm. Your options are:

0 -- without mention of thyrotoxic crisis of storm or

1 -- with mention of thyrotoxic crisis of storm.

After treatment, the patient has a condition called postablative hypothyroidism or hypothyroidism following therapy such as irradiation or the administration of radioactive iodine. Once the thyroid has been ablated, code 244.1 (Other postablative hypothyroidism). There are also codes to use if the thyroid was surgically removed: 244.0 (Postsurgical hypothyroidism) and 244.2 (Iodine hypothyroidism) used when ingestion of iodine that is not radioactive was the cause of the hypothyroidism.