Primary Care Coding Alert

Question: An established patient who recently had surgery and radiation therapy to treat her thyroid cancer reports to the FP 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 [...]