Understand Acquired Hypothyroidism, also known as Hypothyroidism or Underactive Thyroid, with this guide for healthcare professionals. Learn about clinical documentation requirements, medical coding for Hypothyroidism (including ICD-10 codes), and diagnostic criteria for Acquired Hypothyroidism. This resource offers information on diagnosis, treatment, and management of Hypothyroidism for improved patient care and accurate medical records.
Also known as
Hypothyroidism, unspecified
Underactive thyroid with no further details.
Autoimmune hypothyroidism
Underactive thyroid caused by the body's own immune system.
Iodine-deficiency hypothyroidism
Underactive thyroid resulting from insufficient iodine intake.
Postprocedural hypothyroidism
Underactive thyroid developing after a medical procedure.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the hypothyroidism due to iodine deficiency?
Yes
Is it congenital?
No
Is it drug-induced?
When to use each related code
| Description |
|---|
| Underactive thyroid, acquired after birth. |
| Underactive thyroid present at birth. |
| Autoimmune thyroiditis causing hypothyroidism. |
Coding E03.9 (hypothyroidism, unspecified) instead of E03.8 (other specified hypothyroidism) when clinical details support acquired type.
Failing to document and code drug-induced hypothyroidism (E03.2) when medication is the causal factor.
Insufficient documentation of postpartum hypothyroidism (O99.0-) impacting accurate coding and reimbursement.
Q: What are the most common causes of acquired hypothyroidism in adults, and how do their diagnostic workups differ?
A: Acquired hypothyroidism in adults is primarily caused by Hashimoto's thyroiditis (autoimmune), iatrogenic hypothyroidism (resulting from radioactive iodine therapy, thyroidectomy, or certain medications), and iodine deficiency (less common in developed countries). Differentiating between these etiologies requires a nuanced approach. Hashimoto's is typically diagnosed through the presence of thyroid peroxidase (TPO) antibodies and thyroglobulin (Tg) antibodies, along with elevated TSH and low free T4 levels. Iatrogenic hypothyroidism is diagnosed based on patient history and medication review, while iodine deficiency is suspected based on dietary history and can be confirmed through urine iodine testing. Consider implementing a diagnostic algorithm that incorporates TSH, free T4, TPO antibody, and Tg antibody testing as a first step, followed by further investigation based on initial findings. Explore how incorporating ultrasound assessment of thyroid morphology can aid in the differentiation process.
Q: How do I differentiate between subclinical hypothyroidism and overt hypothyroidism in patients, and when is treatment indicated for each?
A: Subclinical hypothyroidism is characterized by mildly elevated TSH levels (typically between 4.0 and 10.0 mIU/L) with normal free T4 levels. Overt hypothyroidism presents with elevated TSH and low free T4 levels. While overt hypothyroidism typically requires levothyroxine treatment, the management of subclinical hypothyroidism is more nuanced and depends on factors such as the presence of TPO antibodies, symptoms, age, and comorbidities like cardiovascular disease. Treatment is often recommended for patients with TPO antibodies, goiter, or overt symptoms. Learn more about the ATA guidelines for the management of subclinical hypothyroidism which advocate for a patient-centered approach that considers individual risk factors and preferences. Consider implementing a shared decision-making process with patients to discuss the benefits and risks of treatment in subclinical cases.
Patient presents with complaints consistent with acquired hypothyroidism, including fatigue, weight gain, cold intolerance, constipation, and dry skin. Symptoms onset has been gradual over the past six months. Patient denies any history of thyroid surgery or radiation therapy to the neck. Family history is positive for autoimmune disorders. Physical examination reveals bradycardia, dry skin, and mild non-pitting edema of the lower extremities. Thyroid gland is not palpable. Laboratory evaluation reveals elevated thyroid stimulating hormone (TSH) level and low free thyroxine (free T4) level, confirming the diagnosis of primary hypothyroidism. Differential diagnosis includes secondary hypothyroidism and other conditions causing similar symptoms, such as depression and anemia. Plan includes initiating levothyroxine therapy, starting at a low dose and titrating based on TSH levels. Patient education provided on medication management, potential side effects, and the importance of regular monitoring of thyroid function tests. Follow-up appointment scheduled in six weeks to assess response to therapy and adjust medication dosage as needed. ICD-10 code E03.9, Hypothyroidism, unspecified, is assigned. Medical billing codes for evaluation and management services, laboratory tests, and medication management will be applied based on the services rendered. This diagnosis and treatment plan were discussed with the patient, and the patient expressed understanding and agreement.