Pathology/Lab Coding Alert

Question: Based on initial lab results indicating hypothyroidism, the physician ordered an anti-thyroperoxidase antibody test and three consecutive TSH tests within an hour following thyrotropin releasing hormone stimulation. Is there a single panel for these tests?


Indiana Subscriber

Answer: CPT does not provide a single code for these tests as an individual panel for hypothyroidism. Instead, you-ll have to code separately for the different tests.

The correct code for anti-thyroperoxidase antibody (TPO-Ab) is 86376 (Microsomal antibodies [e.g., thyroid or liver-kidney], each). The physician will often order this test to determine if the cause of hypothyroidism is an autoimmune disorder such as Hashimoto's thyroiditis. When preliminary lab tests show an elevated level of thyroid stimulating hormone (TSH) and a low level of total thyroxine (TT4) indicating hypothyroidism, the physician may order the antibody test.

The physician may suspect a different form of hypothyroidism if the patient showed a low TT4 with a normal TSH on initial testing. To further define the diagnosis and determine if the hypothyroidism is due to pituitary dysfunction, the physician may order a thyrotropin releasing hormone stimulation panel.

Use panel when you can: You stated that the lab performed three consecutive TSH tests within an hour following thyrotropin releasing hormone stimulation. You should not report this service as 84443 x 3 (Thyroid stimulating hormone [TSH]), because CPT provides a more specific code for the service. Instead, you should use 80438 (Thyrotropin releasing hormone [TRH] stimulation panel; one hour) to describe the service.