Internal Medicine Coding Alert

Question: An established patient who recently had  surgery and radiation therapy to treat her thyroid cancer reports to the internist 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: Your diagnosis coding should be more precise for this patient, as 244.9 (Unspecified hypothyroidism) does not reflect the postsurgical/postradiation state of the patient's 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).

So let's say that the encounter notes indicate that the patient had radiation therapy more recently than thyroid surgery. On the claim, report the following:

• 99214 -- Office or other outpatient visit for the evaluation and management of a patient, which requires at least 2 of these 3 key components: a detailed history; a detailed examination; medical decision-making of moderate complexity, for the E/M
• 244.1 linked to 99214, to indicate that the primary reason for the encounter is acquired hypothyroidism due to the radiation treatment that the patient had recently; and
• 193 -- Malignant neoplasm of thyroid gland, linked to 99214 as a secondary diagnosis to represent the patient's thyroid cancer.