Hypothyroidism – Diagnosis and Coding Guidelines

Touseef Riaz

August 27, 2021


Hypothyroidism is a fairly common condition where the thyroid gland does not create enough thyroid hormone in the blood. Without the right amount of thyroid in the blood, metabolism starts to slow down which can lead to tiredness, gain in weight, and intolerance to cold temperatures.


The condition is known to affect women more than men. According to reports from the American Thyroid Association, over 20 million Americans are affected by some form of thyroid disease annually.  Moreover, most people are not aware of their condition and hence do not get the proper treatment. It is important, therefore, that the condition be accurately diagnosed and then coded for medical billing and reimbursement purposes.

Symptoms of Hypothyroidism

Depending on the severity of the hormone deficiency, the symptoms of hypothyroidism may vary. Signs start to show gradually, often over a number of years.

The early signs of hypothyroidism include a steady weight gain and a feeling of fatigue and tiredness. These signs are often overlooked and attributed to age. As the condition progresses over the years, the metabolism continues to slow and more serious problems develop.

Some common symptoms include:

  • Tiredness
  • Intolerance to cold
  • Gain in weight
  • Constipation
  • Skin dryness
  • Muscle weakness
  • Higher levels of cholesterol
  • Stiff muscles
  • Swelling in joints
  • Irregular menstrual periods
  • Slowed heart rate
  • Enlarged thyroid gland
  • Depression

Diagnosis of Hypothyroidism

Your healthcare physician may test you for hypothyroidism if you have one or more of the symptoms described above. Blood tests are conducted to find out the levels of thyroxine, the thyroid hormone produced naturally by the gland, as well as the level of TSH.

If the blood test reports a lower than normal level of thyroxine and a high level of TSH, that would indicate an underactive thyroid.

TSH is produced by the pituitary gland in an effort to stimulate the thyroid gland to produce more thyroxine, so checking the levels of TSH in the blood is a good screening test to check if the thyroid gland is functioning abnormally. TSH levels also help your physician determine the dosage of medication that is to be administered.

Treatment for Hypothyroidism

In almost every case, hypothyroidism can be controlled but not completely cured. The treatment process works to replace the amount of thyroxine that the thyroid gland is no longer making, as well as bringing the TSH levels back to normal.

Treatment for Hypothyroidism

A popular treatment is the administration of synthetic thyroxine pills, which are exactly like the T4 hormones created by the thyroid gland. Taken orally, the medication restores the hormone levels and helps reverse the symptoms of hypothyroidism.

Coding for Hypothyroidism ICD-10

Hypothyroidism is classified into categories from E00 to E07 Chapter 4 of the ICD-10-CM manual. The categories are:

  • E00, Congenital hypothyroidism ICD-10
  • E01, Iodine-deficiency related thyroid disorders and allied conditions;
  • E02, Subclinical iodine-deficiency hypothyroidism;
  • E03, Other hypothyroidism;
  • E04, Other nontoxic goiter;
  • E05, Thyrotoxicosis [hyperthyroidism];
  • E06, Thyroiditis;
  • E07, Other disorders of thyroid;

When compared to the ICD-9, the coding directive is almost the same in the ICD-10-CM. However, some conditions fall into different chapters in the current code set. For instance, the code for postsurgical hypothyroidism was classified to code 244.0. Whereas, in the ICD-10, it is renamed to postprocedural hypothyroidism ICD-10 is located at E89.0.


Hypothyroidism is a condition that cannot be completely cured and is often a lifelong situation. There is no way to prevent hypothyroidism, but people who have a high risk of thyroid problems, (for example, women during pregnancy) should check with their doctor about the need for additional iodine.

For most people, medication is beneficial and helps reduce the symptoms. But it is important to ensure a healthy lifestyle that incorporates regular exercise and nutritious food along with the medication to better manage hypothyroidism.

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