THYROID FUNCTION TESTING THYROID STIMULATING HORMONE THYROXINE; FREE, (T4) THYROXINE; TOTAL, (T4) TRIIODOTHYRONINE (T3); RESIN UPTAKE

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1 Test Code Test Name CPT T4 Thyroxine; Total (T4) T4FRE Thyroxine; Free (T4 free) T4FR T4 Free Dialysis TSH Thyroid Stimulating Hormone (TSH) T3UP Triiodothyronine (T3); Resin uptake TSHR Thyroid Stimulating Hormone (w/ Thyroxine Reflex) (84439) THYP Thyroid Profile TPTSH Thyroid Profile w/ TSH MEDICARE LIMITATIONS AND GUIDELINES: Testing may be covered up to two times a year in clinically stable patients; more frequent testing may be reasonable and necessary for patients whose thyroid therapy has been altered or in whom symptoms or signs of hyperthyroidism or hypothyroidism are noted.

2 Narrative Description ICD9 Abnormal EKG Abnormal involuntary movements Abnormal loss of weight Abnormal weight gain Acquired hypothyroidism Acute paranoid reaction Acute respiratory failure Adrenogenital disorders Affective psycoses Agitation other and unspecified special symptoms or syndromes, not elsewhere classified Alopecia Alteration of consciousness, other Altered Mental status Alzheimer s, pick s disease, Senile degeneration of brain 331.0, , , Anemia, unspecified Anomaly of other endocrine glands Anorexia Anorexia nervosa Anxiety states Ariboflavinosis Ascites Atrial fibrillation Autoimmune disease, not elsewhere classified Autoimmune hemolytic anemia Autoimmune Lymphoproliferative syndrome Benign neoplasm of ovary 220 Benign neoplasm of pituitary gland and craniopharyngeal duct Benign neoplasm of thyroid gland 226

3 Blepharoptosis Calcium disorders Carcinoma in situ of other and unspecified sites Cardiac dysrhythmia, unspecified Cardiomegaly Carpal Tunnel syndrome Changes in skin texture Chills (without fever) Coma Combinations of endocrine dysfunction Congenital hypothyroidism 243 Congestive heart failure, unspecified Conjunctival edema Conjunctival hyperemia Constipation , Constipation , Delirium Demoralization and apathy Depressive disorder, not elsewhere classified 311 Diabetes mellitus Diffuse disease of connective tissue Diplopia Disorders of menstruation Disturbance of skin sensation Dysarthria Dysmenorrhea Dysphagia Dysphagia, oral phase Dysphagia, oropharyngeal phase

4 Dysphagia, pharyngeal phase Dysphagia, unspecified Dysphonia Early satiety Effects of radiation, unspecified 990 Emotional lability Engorgement of breast associated with childbirth and disorders of lactation Essential and other specified forms of tremor Essential hypertension Exophthalmic conditions, unspecified and constant Exophthalmic ophthlmoplegia Eyelid edema Fever presenting with conditions classified elsewhere Fever, unspecified Follow-up examination V67.0 V67.9 Functional quadriplegia Generalized pain Glucocorticoid deficiency Goiter specified and unspecified Hungry bone syndrome Hypercarotinemia Hyperhidrosis Hypernasality Hypertensive chronic kidney disease Hypertensive heart and chronic kidney disease Hyponasality Hypoparathyroidism Hyposmolality and/or hypernatremia Hyposmolality and/or hyponatremia 276.1

5 Hypothermia not associated with low environmental temperature Idiopathic osteoporosis Idiopathic peripheral neuropathy, unspecified polyneuropathy Impulsiveness Insomnia Insomnia due to medical condition classified elsewhere Irregular menstrual cycle Irritability Keratoderma, acquired (dry skin) Lack of coordination, ataxia Latrogenic pituitary disorders Left heart failure Lid retraction or lag Localized edema Long term (current) use of other medications V58.69 Macroglossia, congenital Malaise and fatigue Malignant ascites Malignant neoplasm of other endocrine glands and related structures, other Malignant neoplasm of ovary Malignant neoplasm of thyroid gland 193 Malnutrition severe 262 Malnutrition, other and unspecified Megacolon, other than Hischsprung s Memory loss Mild cognitive impairment, so stated Mineralocorticoid deficiency Mixed hyperlipidemia Mood changes 309.1

6 Multiple endocrine neoplasia (MEN) type I Multiple endocrine neoplasia (MEN) type IIA Multiple endocrine neoplasia (MEN) type IIB Muscle wasting Muscle weakness Musculoskeletal cramp Myalgia and myositis, unspecified Myasthenic syndromes in diseases classified elsewhere Myopathy Myopathy in endocrine diseases classified elsewhere Myopathy, unspecified Neonatal thyrotoxixosis Neoplasm of uncertain behavior of other and unspecified endocrine glands Nervousness Nontoxic nodular goiter Nutritional and metabolic cardiomyopathy Orbitaledema or congestion, intermittent exophthalmos Organic insomnia, unspecified Organic personality syndrome Osteoporosis, drug induced Other and unspecified anterior pituitary hyper function Other and unspecified hyperlipidemia Other anterior pituitary disorders Other current conditions in the mother, classifiable elsewhere, but complicating pregnancy, childbirth, or the puerperium, thyroid dysfunction Other disorders of thyroid Other extrapyramidao diseases and abnormal movement disorders Other general symptoms Other nonspecific abnormal findings on radiological and other examinations of body structure. Other nonspecific abnormal findings, abnormal reflex 796.1

7 Other organic insomnia Other organic sleep disorders Other ovarian failure , Other signs and symptoms involving emotional state Other specified cardiac dysrhythmia Other specified conditions of the tongue Other specified diseases of nail (Brittle nails) Other specified organic brain syndromes Other speech disturbance Other speech disturbance Other symptoms involving cardiovascular system Other symptoms involving digestive system Other symptoms involving respiratory system Other symptoms involving skin and integumentary tissues Palpitations Panhypopituitarism Paralytic ileus Paralytic strabismus Paranoia Paranoid state, simple Paroxysmal supraventricular tachycardia Paroxysmal tachcardia, unspecified Periostitis without osteoyelitis Peritoneal effusion (chronic) Pernicious anemia Personal history of endocrine, metabolic and immunity disorders V12.2 Personal history of malignant neoplasm of other endocrine gland V10.88 Personal history of malignant neoplasm of the thyroid V10.87 Personal history of malignant neuroendocrine tumor V10.91

8 Pituitary disorders 253.8; 256.3; Pituitary dwarfism Polyglandular dysfunction, unspecified Polygrandular dysfunction, other specified Polyphagia Postprocedural fever Postvaccination fever Presenile dementia Pure hypercolesterolemia Secondary malignant neoplasm of the thyroid Senile dementia with delirium Senile dementia with delusional or depressive fetures Senile dementia, uncomplicated Sleep disturbance Sleep related leg cramp Stridor Tachycardia, unspecified Testicular hypofunction Throat pain Thyroid, abnormal scan or uptake Thyroiditis Thyrotoxic exophthalmos Thyrotoxicosis with or without goiter Transient alteration of awareness Transient organic mental disorders Tuberculosis of the thyroid gland Unspecified deficiency anemia Unspecified disease of pericardium Unspecified disorder of muscle, ligament, and fascia 728.9

9 Unspecified paranoid state Unspecified pleural effusion Unspecified pruritic disorder Vitiligo Voice disturbance Weight change Xerosis

10 THYROXINE; FREE, ICD CODES NUMERICAL ORDER ; 256.3; , , , ,

11 THYROXINE; FREE, ICD CODES NUMERICAL ORDER , ,

12 THYROXINE; FREE, ICD CODES NUMERICAL ORDER