This week’s blog is short because it is my hope that you will consider taking some time to peruse the list below. This list comes from the Medicare National Coverage Determinations report. Extracted from that report is the Thyroid Testing list (below). The list indicates that thyroid function testing may be medically necessary with the following patient conditions/complaints/symptoms.
It is important to note that many major insurance companies adopt Medicare’s (The government) reimbursement coverage guidelines.
So the next time a doctor says to you “I don’t think your symptoms are “thyroid related” show them this list. I had an ER doctor tell me one time that memory loss has nothing to do with thyroid disease. It would have been great to have this list at the time…I could’ve said “Nuh Uh buddy, check out code number 780.93.”
The government assembles a team primarily of doctors to create, update, review and edit this list annually.
Here is the entire 2013 Medicare National Coverage Determinations Report - http://www.cms.gov/Medicare/Coverage/CoverageGenInfo/downloads/manual201301.pdf
THYROID TESTING LIST
Code | Description |
017.50-017.56 | Tuberculosis of the thyroid gland |
183.0 | Malignant neoplasm of ovary |
193 | Malignant neoplasm of thyroid gland |
194.8 | Malignant neoplasm of other endocrine glands and related structures |
198.89 | Secondary malignant neoplasm of the thyroid |
220 | Benign neoplasm of ovary |
226 | Benign neoplasm of thyroid gland |
227.3 | Benign neoplasm of pituitary gland and craniopharyngeal duct |
234.8 | Carcinoma in situ of other and unspecified sites |
237.4 | Neoplasm of uncertain behavior of other and unspecified endocrine glands |
239.7 | Neoplasm of unspecified nature, thyroid gland |
240.0-240.9 | Goiter specified and unspecified |
241.0-241.9 | Nontoxic nodular goiter |
242.00-242.91 | Thyrotoxicosis with or without goiter |
243 | Congenital hypothyroidism |
244.0-244.9 | Acquired hypothyroidism |
245.0-245.9 | Thyroiditis |
246.0-246.9 | Other disorders of thyroid |
249.00-249.01 | Secondary diabetes mellitus without mention of complication |
249.10-249.11 | Secondary diabetes mellitus with ketoacidosis |
249.20-249.21 | Secondary diabetes mellitus with hyperosmolarity |
249.30-249.31 | Secondary diabetes mellitus with other coma |
249.40-249.41 | Secondary diabetes mellitus with renal manifestations |
249.50-249.51 | Secondary diabetes mellitus with ophthalmic manifestations |
249.60-249.61 | Secondary diabetes mellitus with neurological manifestations |
249.70-249.71 | Secondary diabetes mellitus with peripheral circulatory disorders |
249.80-249.81 | Secondary diabetes mellitus with other specified manifestations |
249.90-249.91 | Secondary diabetes mellitus with unspecified complication |
250.00-250.93 | Diabetes mellitus |
252.1 | Hypoparathyroidism |
253.1 | Other and unspecified anterior pituitary hyper function |
253.2 | Panhypopituitarism |
253.3 | Pituitary dwarfism |
253.4 | Other anterior pituitary disorders |
253.7 | Iatrogenic pituitary disorders |
255.2 | Adrenogenital disorders |
255.41 | Glucocorticoid deficiency |
255.42 | Mineralocorticoid deficiency |
256.31-256.39 | Ovarian failure |
257.2 | Testicular hypofunction |
258.0 – 258.9 | Polyglandular dysfunction and related disorders |
262 | Malnutrition, severe |
263.0-263.9 | Malnutrition, other and unspecified |
266.0 | Ariboflavinosis |
272.0 | Pure hypercholesterolemia |
272.2 | Mixed hyperlipidemia |
272.4 | Other and unspecified hyperlipidemia |
275.40-275.49 | Calcium disorders |
275.5 | Hungry bone syndrome |
276.0 | Hyposmolality and/or hypernatremia |
276.1 | Hyposmolality and/or hyponatremia |
278.3 | Hypercarotenemia |
279.41 | Autoimmune lymphoproliferative syndrome |
279.49 | Autoimmune disease, not elsewhere classified |
281.0 | Pernicious anemia |
281.9 | Unspecified deficiency anemia |
283.0 | Autoimmune hemolytic anemia |
285.9 | Anemia, unspecified |
290.0 | Senile dementia, uncomplicated |
290.10-290.13 | Presenile dementia |
290.20-290.21 | Senile dementia with delusional or depressive features |
290.3 | Senile dementia with delirium |
293.0-293.1 | Delirium |
293.81-293.89 | Other specified transient mental disorders due to conditions classified elsewhere |
294.8 | Other persistent mental disorders due to conditions classified elsewhere |
296.00-296.99 | Episodic mood disorders |
297.0 | Paranoid state, simple |
297.1 | Delusional disorder |
297.9 | Unspecified paranoid state |
298.3 | Acute paranoid reaction |
300.00-300.09 | Anxiety states |
307.9 | Other and unspecified special symptoms or syndromes NEC |
310.1 | Personality change due to conditions classified elsewhere |
311 | Depressive disorder, NEC |
327.00 | Organic insomnia, unspecified |
327.01 | Insomnia due to medical condition classified elsewhere |
327.09 | Other organic insomnia |
327.29 | Other organic sleep apnea |
327.52 | Sleep related leg cramps |
327.8 | Other Organic sleep disorders |
331.0, 331.11, 331.19, 331.2 | Alzheimer’s, pick’s disease, Senile degeneration of brain |
331.83 | Mild cognitive impairment, so stated |
333.1 | Essential and other specified forms of tremor |
333.99 | Other extrapyramidal diseases and abnormal movement disorders |
354.0 | Carpal Tunnel syndrome |
356.9 | Idiopathic peripheral neuropathy, unspecified polyneuropathy |
358.1 | Myasthenic syndromes in diseases classified elsewhere |
359.5 | Myopathy in endocrine diseases classified elsewhere |
359.9 | Myopathy, unspecified |
368.2 | Diplopia |
372.71 | Conjunctival hyperemia |
372.73 | Conjunctival edema |
374.41 | Lid retraction or lag |
374.82 | Eyelid edema |
376.21 | Thyrotoxic exophthalmos |
376.22 | Exophthalmic ophthalmoplegia |
376.30-376.31 | Exophthalmic conditions, unspecified and constant |
376.33-376.34 | Orbital edema or congestion, intermittent exophthalmos |
378.50-378.55 | Paralytic strabismus |
401.0-401.9 | Essential hypertension |
403.00-403.91 | Hypertensive chronic kidney disease |
404.00-404.93 | Hypertensive heart and chronic kidney disease |
423.9 | Unspecified disease of pericardium |
425.7 | Nutritional and metabolic cardiomyopathy |
427.0 | Paroxysmal supraventricular tachycardia |
427.2 | Paroxysmal tachycardia, unspecified |
427.31 | Atrial fibrillation |
427.89 | Other specified cardiac dysrhythmia |
427.9 | Cardiac dysrhythmia, unspecified |
428.0 | Congestive heart failure, unspecified |
428.1 | Left heart failure |
429.3 | Cardiomegaly |
511.9 | Unspecified pleural effusion |
518.81 | Acute respiratory failure |
529.8 | Other specified conditions of the tongue |
560.1 | Paralytic ileus |
564.00-564.09 | Constipation |
564.7 | Megacolon, other than Hirschsprung’s |
568.82 | Peritoneal effusion (chronic) |
625.3 | Dysmenorrhea |
626.0-626.2 | Disorders of menstruation |
626.4 | Irregular menstrual cycle |
648.10-648.14 | Other current conditions in mother, classifiable elsewhere, but complicating pregnancy, childbirth, or puerperium, thyroid dysfunction |
676.20-676.24 | Engorgement of breast associated w/ childbirth & disorders of lactation |
698.9 | Unspecified pruritic disorder |
701.1 | Keratoderma, acquired (dry skin) |
703.8 | Other specified diseases of nail (Brittle nails) |
704.00-704.09 | Alopecia |
709.01 | Vitiligo |
710.0-710.9 | Diffuse disease of connective tissue |
728.2 | Muscle wasting |
728.87 | Muscle weakness (generalized) |
728.9 | Unspecified disorder of muscle, ligament, and fascia |
729.1 | Myalgia and myositis, unspecified |
729.82 | Musculoskeletal cramp |
730.30-730.39 | Periostitis without osteomyelitis |
733.02 | Idiopathic osteoporosis |
733.09 | Osteoporosis, drug induced |
750.15 | Macroglossia, congenital |
759.2 | Anomaly of other endocrine glands |
780.01 | Coma |
780.02 | Transient alteration of awareness |
780.09 | Alteration of consciousness, other |
780.50 | Insomnia |
780.51 | Insomnia with sleep apnea, unspecified |
780.52 | Insomnia, unspecified |
780.60 | Fever, unspecified |
780.61 | Fever presenting with conditions classified elsewhere |
780.62 | Postprocedural fever |
780.63 | Postvaccination fever |
780.64 | Chills (without fever) |
780.65 | Hypothermia not associated with low environmental temperature |
780.66 | Febrile nonhemolytic transfusion reaction |
780.71 | Chronic fatigue syndrome |
780.72 | Functional quadriplegia |
780.79 | Other malaise and fatigue |
780.8 | Generalized hyperhidrosis |
780.93 | Memory loss |
780.94 | Early satiety |
780.96 | Generalized pain |
780.97 | Altered mental status |
780.99 | Other general symptoms |
781.0 | Abnormal involuntary movements |
781.3 | Lack of coordination, ataxia |
782.0 | Disturbance of skin sensation |
782.3 | Localized edema |
782.8 | Changes in skin texture |
782.9 | Other symptoms involving skin and integumentary tissues |
783.0 | Anorexia |
783.1 | Abnormal weight gain |
783.21 | Abnormal loss of weight |
783.6 | Polyphagia |
784.1 | Throat pain |
784.42 | Dysphonia |
784.43 | Hypernasality |
784.44 | Hyponasality |
784.49 | Other voice and resonance disorders |
784.51 | Dysarthria |
784.59 | Other speech disturbance |
785.0 | Tachycardia, unspecified |
785.1 | Palpitations |
785.9 | Other symptoms involving cardiovascular system |
786.09 | Other symptoms involving respiratory system |
786.1 | Stridor |
787.20 | Dysphagia, unspecified |
787.21 | Dysphagia, oral phase |
787.22 | Dysphagia, oropharyngeal phase |
787.23 | Dysphagia, pharyngeal phase |
787.24 | Dysphagia, pharyngo-esophageal phase |
787.29 | Other dysphagia |
787.91-787.99 | Other symptoms involving digestive system |
789.51 | Malignant Ascites |
789.59 | Other Ascites |
793.99 | Other nonspecific (abnormal) findings on radiological and other examination of body structure |
794.5 | Thyroid, abnormal scan or uptake |
796.1 | Other nonspecific abnormal findings, abnormal reflex |
799.21 | Nervousness |
799.22 | Irritability |
799.23 | Impulsiveness |
799.24 | Emotional lability |
799.25 | Demoralization and apathy |
799.29 | Other signs and symptoms involving emotional state |
990 | Effects of radiation, unspecified |
V10.87 | Personal history of malignant neoplasm of the thyroid |
V10.88 | Personal history of malignant neoplasm of other endocrine gland |
V10.91 | Personal history of malignant neuroendocrine tumor |
V12.21 | Personal history of gestational diabetes |
V12.29 | Personal history of other endocrine, metabolic, and immunity disorders |
V58.69 | Long term (current) use of other medications |
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In this long list of conditions that are currently taken to be grounds for thyroid testing (those items that aren't obviously thyroid conditions, that is: those conditions would presumably be identified by thyroid testing, rather than being grounds for undertaking it), many have a range of potential causes, many of which are more common causes than thyroid dysfunction, e.g. the thyroid is not listed as a common cause of 'Malignant neoplasm of ovary'. Loss of memory is well known to have a number of possible causes. So if 'a doctor says to you 'I don’t think your symptoms are “thyroid related”', their reasons for saying so might be that there is a more likely cause or causes in your case, not necessarily because they do not know that SEVERE hypothyroidism can be a cause of memory loss. Certainly if your doctor declared that there is no connection between the conditions he was wrong, but he might not have been wrong if he'd told you that he didn't think it was the cause in your case. The list of conditions is striking, but without any accompanying list of the percentage of known cases in which thyroid disfunction has figured as a cause for each condition, it is not, on its own, a useful guide, still less an authoritative source for challenges to or discussions with your GP.
ReplyDeleteHi Kevin,
DeleteThis list shows that these conditions COULD be thyroid related. I am not saying that each person who has these symptoms also has a thyroid condition, that is not realistic. I think the point to be made here is that MD’s should NEVER tell a thyroid sufferer that if their hair is falling out or if they have memory loss, etc…that it is unequivocally not thyroid related. Unless they can back that up with 100% proof of what is REALLY causing the issue. That ER doctor knew I had a thyroid condition and he told me that my memory loss was not thyroid related, but did not offer me any other suggestions of what it could be… these responses from doctors are typical.
And if I may ask, if there was a percentage offered for each item on this list…what exactly would that do to validate this list?
This is where I meant to place this....Well....considering this list...it seems like a reasonable idea to perform the blookwork neccessary to eliminate thyroid disease as a possible cause. Some of the tests I was put through were way more extensive and expensive...and of course they turned up nothing....if someone had just tested my thyroid they would not have needed to waste my time and money with neurologists, gastroenterologists,dermatologists and cardiologists. Even just a simple TSH test, while not the best, would have pointed me in the right direction and saved me years of misery.....BTW....not one of the 5 endocrinologists I have seen was even interested in considering my symptoms of brain fog, the strange skin rashes and my digestive issues as thyroid related....that fact does not reassure me that a GP is any more qualified to comment on how the conditions on the list may or may not be thyroid related.
Deletemy doctor told me just this week, that thyroid effects every cell in the body, therefore can be the cause of symptom or disease.
DeleteAnonymous, Aug 30, 13 - who is your doctor! If he/she is in the Boston area, I want to make an appointment!
DeleteThis is a great list.,I book mark it to keep.
ReplyDeleteWell....considering this list...it seems like a reasonable idea to perform the blookwork neccessary to eliminate thyroid disease as a possible cause. Some of the tests I was put through were way more extensive and expensive...and of course they turned up nothing....if someone had just tested my thyroid they would not have needed to waste my time and money with neurologists, gastroenterologists,dermatologists and cardiologists. Even just a simple TSH test, while not the best, would have pointed me in the right direction and saved me years of misery.....BTW....not one of the 5 endocrinologists I have seen was even interested in considering my symptoms of brain fog, the strange skin rashes and my digestive issues as thyroid related....that fact does not reassure me that a GP is any more qualified to comment on how the conditions on the list may or may not be thyroid related.
ReplyDeleteI have a majority of these symptoms with my hypothyroidism.
ReplyDeleteThank you so much. I've heard that remark about "it's not your thyroid" over and over and have tried to convince my endo that there is much to learn. He does agree with that one. But in the meantime, it does not help me or you one bit.
ReplyDeleteFantastic information as always Carol. It never ceases to amaze me how little front line healthcare providers know about all things "thyroid". Yet their ego/arrogance prevents them from admitting they do not know everything.
ReplyDeleteI hope you are well, take care, Robert.
Thank you for posting this. I've saved all the pages from the original site in my arsenal should I need it.
ReplyDeleteMy endocrinologist told me that the nightly severe leg cramps I was having for hours on end every night had nothing to do with my thyroid. He suggested I was dehydrated. When I told him I keep a 24 oz tumbler at my desk and drink no less than 5 per day of water while at work plus I drink water at home, still said it was just dehydration. Then he increased my meds based off of my blood work and magically the cramps went away....yeah nothing to do with it.
ReplyDeleteThank you so much for the wonderful information.This is really important for me.I am searching this kind of information from a long time and finally got it.
ReplyDeleteYour website is terribly informative and your articles are wonderful.
ReplyDeleteRenal test online
Thanks for the brilliant info. I wish our Drs were so informative.
ReplyDeleteSome of my favorite thyroid sites:
ReplyDeletewww.wilsonssyndrome.com
www.stopthethyroidmadness.com
https://w3.brownsteinhealth.com/LP/Health/DRB/Thyroid-Disorder-Video-G?dkt_nbr=jyj7wuqt
http://www.eje.org/content/early/2008/12/18/EJE-08-0837.full.pdf