TSH CPT Code 84443 | Description, Guidelines, Reimbursement, Modifiers & Examples

CPT code 84443 reports services when a test is performed to measure the thyroid-stimulating hormone (TSH). This hormone helps determine an overactive or underactive thyroid hormone secretion.

TSH CPT Code | Description & Explanation

TSH CPT code 84443 is used to determine the measure of the Thyroid-stimulating-hormone (TSH). This test also aids in effectively treating the thyroid gland and indicates over and underactive thyroid glands.

The official description of CPT 84443 is: “Thyroid stimulating hormone (TSH).”

TSH CPT code 84443 forms in the pituitary gland and plays a significant role in the secretion and stimulation of thyrotropin (T3) and thyroxine (T4), which aids in quantifying TSH. The specimen is collected in the form of serum and needs special handling.

Samples are retrieved via heel stick or umbilical cord and sometimes through special paper for newborns. Some multiple methods or techniques can be used, which are as follows:

• Sandwich immunoradiometric assay (IRMA)
• Radioimmunoassay (RIA)
• Microparticle enzyme immunoassay on IMx (MEIA)
• Fluorometric enzyme immunoassay, which includes monoclonal antibody

CPT (Current Procedural Terminology) 84443 test service is performed to diagnose and treat various diseases related to the thyroid gland. It is performed when the thyroid secretes hormones too high or too low in the thyroid gland.

There are the following diseases, signs, and symptoms when TSH CPT code 84443 is done:

• Aid to diagnose hyperthyroidism
• Graves’ disease
• To Distinguish from several types of hypothyroidism (e.g., primary and pituitary/hypothalamic)
• to determine congenital hypothyroidism
• Thyroid cancer, goiter, or thyroid nodules
• It can evaluate whether therapy is effective or not for the treatment of hypothyroidism.

Signs and Symptoms: Tachycardiac, weight gain, hair loss, sleeping dysfunction, anxiety or depression, Tremors in an upper extremity like hands, Eyes bulging, Menstrual period problems, constipation, body aches, etc. 

Reimbursement

A maximum of 4 units of TSH CPT code 84443 can be billed on the same service date.

The reimbursement of CPT 84443 is as follows, and RUVS is not applicable for Pathology and laboratory procedure codes (CPT 80047- 89398):

• CPT With QW modifier: 16.80$
• CPT Without QW modifier: 16.80$

CPT 84443 is CLIA (Clinical Laboratory Improvement Amendments) approved code. Therefore, Modifier QW will be appended with CPT code 84443 if applicable.

When To Use Modifiers

Modifier 59 is appropriate to bill with TSH CPT code 84443 when another laboratory procedure is billed with test TSH (CPT 84443) on the same service date but a specific anatomical site. For instance, a patient is presented to a pathologist to determine the thyroid hormone level, and samples are taken to determine the level.

Another sample was retrieved from a different location site like the nose. Modifier 59 will be attached to CPT 84443 if applicable. HCPCS Modifier X {E, P, S, U} can be used instead of 59 for further code specificity if billed to Medicare insurance.

Modifier 91 will be appended with TSH CPT code 84443 when repeated on the same day due to medical conditions or other circumstances. 

Modifiers 79 and 78 are applicable with CPT 84443 when bundled with other medical procedures in the postoperative period. If a condition is related to a prior procedure with a global period, then Modifier 78 is appropriate to bill with TSH CPT code 84443, and Modifier 79 is for unrelated conditions.

Modifier 58 will be used with CPT 84443 when the procedure is done that has a global period. The physician plans to do CPT 84443 service at a specific time or part of the procedure necessary to perform in the postoperative period. Then modifier 58 is applicable. At the same time, 78 is suitable for unplanned patient return due to complications.

Billing & Coding Guidelines 

CPT 84443 service should be medically appropriate and necessary to support the documentation. ICD 10 codes should be related to the thyroid gland, such as C73 (Malignant neoplasm of the thyroid gland), E03.9 (Hypothyroidism, unspecified), R94.6 (Abnormal results of thyroid function studies), E06.9 (Thyroiditis, unspecified), etc.

ICD codes must prove the medical necessity of service according to their respective LCD (Local Coverage Determination) and NCD (National Coverage Determination).

Modifier QW is appropriate to attach with CPT 84443 as it is a CLIA-approved code and heck the payer guidelines or insurances to append QW modifier on the claim.

TSH CPT code 84443 is inappropriate to bill for Thyroid-stimulating immune globulins (TSI). It will be reported with CPT code 84445 and separately payable without any modifier requirement.

CPT 84443 includes the following services Clinical information not requested by the ordering physician, Quantitative analysis unless otherwise specified, mathematically calculated results, and Specimens from any source unless otherwise specified

CPT 84443 is included in multiple panel codes. It is appropriate to bill separately with modifiers if a particular service is performed on the same day in addition to panel CPT codes. It is included in CPT 80418 (Combined rapid anterior pituitary evaluation panel), 80439 (Thyrotropin-releasing hormone (TRH) stimulation panel), which has four units of TSH CPT code 84443, and CPT 80438, has three units of CPT 84443.

The services not included in CPT 84443 are as follows; Analytes from Non requested laboratory analysis, calculated results representing a score or probability derived by algorithm, Organ, or disease panels (80048-80076, 80081). Panel codes are used for coding purposes only and will not influence the reimbursement of CPT 84443.

TSH CPT code 84443 is separately reportable when performed in combination with Therapeutic drug assays (80150-80299, 80164, 80165, 80171) without any modifier according to NCCI (National Correct Coding Initiative)

Modifier TC (Technical component) and 26 (professional component) are inappropriate to attach with CPT code 84443.

If CPT 8443 is done with evaluation and management CPT codes (99202-99499), it is allowed to bill separately and be payable. The modifier is not required to append with CPT 84443 according to NCCI. Therefore, check the payer or third-party guidelines if the modifier must be added with TSH CPT code 84443. 

Billing Examples

The following are billing examples for the CPT code for TSH (84443).

Example 1

A 36-year-old male presents to the office with no PMH of any disease. He has sudden weight gain and alopecia problems but has no additional symptoms with the following complaints. He denies headaches, body aches, numbness, dizziness, weakness, chest pain, and shortness of breath.

The physical exam revealed that the patient had abnormal thyroid levels. The differential diagnosis code was hypothyroidism. The physician ordered multiple diagnostic labs and radiology tests like TSH and CTA neck to confirm the patient’s condition.

The Diagnostic tests confirmed that the patient had hypothyroidism and was prescribed medicine for the treatment.

Billing:

CPT Codes:

• CPT 99203: Office or other outpatient visit for the evaluation and management of a new patient: This code is used for the initial office visit where the patient presented with sudden weight gain and alopecia problems, and abnormal thyroid levels were discovered.
• CPT 84443: Assay of thyroid stimulating hormone (TSH): This code is used to document the TSH lab test ordered by the physician to evaluate the patient’s thyroid function.
• CPT 70498: Computed tomographic angiography, neck, with contrast material(s), including non-contrast images, if performed, and image post-processing: This code is used to document the CTA neck radiology test ordered by the physician to evaluate the patient’s condition further.

ICD-10 Codes:

• ICD 10 E03.9: Hypothyroidism, unspecified: This code is used to document the patient’s diagnosis of hypothyroidism, which was confirmed by the diagnostic tests.
• ICD 10 R63.5: Abnormal weight gain: This code documents the patient’s complaint of sudden weight gain.
• ICD 10 L65.9: Nonscarring hair loss, unspecified: This code documents the patient’s alopecia problem.

Example 2

A 40-year-old male presents to the office for four days of muscle fatigue and digestive system issues with no medical or personal history. The patient has abdominal cramps and takes medication to lower the cramps, but the condition worsens when lying down.

The patient denies chest pain, shortness of breath, numbness, cardiovascular disorders, headache, eyes problem, and dysuria. The physical exam revealed that the patient has dry skin, Abdominal tenderness and swelling, and pain in both upper and lower extremities.

The Physician orders multiple tests CT, MRI, X-ray of the abdomen and pelvis, and lab tests Like TSH or CBC to confirm the diagnosis. Lab and pathology tests confirmed that the patient has hypothyroidism.

Billing:

CPT Codes:

• CPT 99203: Office or other outpatient visit for the evaluation and management of a new patient: This code is used for the initial office visit where the patient presented with muscle fatigue, digestive system issues, and worsening abdominal cramps.
• CPT 74176: Computed tomography, abdomen and pelvis; without contrast material: This code is used to document the CT of the abdomen and pelvis ordered by the physician.
• CPT 72195: Magnetic resonance (e.g., MRI), pelvis; without contrast material(s): This code is used to document the MRI of the pelvis ordered by the physician.
• CPT 71020: Radiologic examination, chest, 2 views, frontal and lateral: This code is used to document the chest X-ray ordered by the physician.
• CPT 84443: Assay of thyroid stimulating hormone (TSH): This code is used to document the TSH lab test ordered by the physician to evaluate the patient’s thyroid function.
• CPT 85025: Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count: This code is used to document the complete blood count (CBC) test ordered by the physician.

ICD-10 Codes:

• ICD 10 E03.9: Hypothyroidism, unspecified: This code is used to document the patient’s diagnosis of hypothyroidism, which was confirmed by the diagnostic tests.
• ICD 10 M62.81: Muscle weakness (generalized): This code is used to document the patient’s complaint of muscle fatigue.
• ICD 10 R10.9: Unspecified abdominal pain: This code documents the patient’s abdominal cramps and worsening condition when lying down.
• ICD 10 L85.5: Other specified disorders of the skin and subcutaneous tissue: This code documents the patient’s dry skin.

Example 3 

A 30-year-old female presented to the office for an irregular menstrual cycle and bradycardic from 3 to 4 days. The physician reviewed the system that confirmed that the patient has digestive problems with constipation and these presenting symptoms.

The patient ate usually and denied sleeping disorders, dizziness, numbness, urinary symptoms, eyes, and ear problems. The physical exam revealed the patient has a rapid heartbeat, constipation, and other digestive issues.

Physician orders Pathology and laboratory tests like CMP (Comprehensive Metabolic Panel), Lipid panel TSH and Radiology tests such as ultrasound of the abdomen, CTA chest, and X-ray of the chest. The study shows that the patient has hypothyroidism.

Billing:

CPT Codes:

• CPT 99203: Office or other outpatient visit for the evaluation and management of a new patient: This code is used for the initial office visit where the patient presented with an irregular menstrual cycle, bradycardia, and digestive problems.
• CPT 80053: Comprehensive metabolic panel: This code documents the CMP laboratory test ordered by the physician to evaluate the patient’s overall metabolic function.
• CPT 80061: Lipid panel: This code documents the lipid panel laboratory test ordered by the physician to assess the patient’s cholesterol and triglyceride levels.
• CPT 84443: Assay of thyroid stimulating hormone (TSH): This code is used to document the TSH lab test ordered by the physician to evaluate the patient’s thyroid function.
• CPT 76705: Ultrasound, abdominal, real-time with image documentation; limited (e.g., single organ, quadrant, follow-up): This code is used to document the abdominal ultrasound ordered by the physician to evaluate the patient’s digestive issues further.
• CPT 71275: Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image post-processing: This code is used to document the CTA chest radiology test ordered by the physician.
• CPT 71045: Radiologic examination, chest; single view: This code is used to document the chest X-ray ordered by the physician.

ICD-10 Codes:

• ICD 10 E03.9: Hypothyroidism, unspecified: This code is used to document the patient’s diagnosis of hypothyroidism, which was confirmed by the diagnostic tests.
• ICD 10 N92.6: Irregular menstruation, unspecified: This code documents the patient’s irregular menstrual cycle complaint.
• ICD 10 R00.1: Bradycardia, unspecified: This code is used to document the patient’s bradycardia.
• ICD 10 K59.00: Constipation, unspecified: This code is used to document the patient’s constipation and digestive problems.

Example 4

A 25-year-old male presents to the emergency department with a past medical history of thyroid cancer and no family history. The patient has had chest pain, rapid heartbeat, anxiety, and dysphagia for the past two weeks. Sudden weight loss is detected these days, and he cannot eat anything.

His vitals show a temperature of 102 Fahrenheit, and he seems distressed upon physical exam. The patient took Tylenol for chest pain and got relief for 3 to 4 hours. Symptoms have worsened for the last two days, and he cannot bear chest pain.

The patient denies any tremors of the upper and lower extremities, headache, skin, or allergies to the urinary bladder. Physical exam study shows that patients are tachycardiac, Abdominal distension anxiety issues.

The physician has ordered medication and a wide range of diagnostic Labs (CBC, CMP, TSH, and Cardiac profile) and radiology tests (CT and MRI of chest, abdomen, and pelvis). Diagnostic studies revealed that the patient has hyperthyroidism and other heart-related diseases. The physician prescribed other medicine to lower thyroid Hormone in the bloodstream.

Billing:

CPT Codes:

• CPT 99283: Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision making of moderate complexity: This code is used for the initial emergency department visit where the patient presented with chest pain, rapid heartbeat, anxiety, and dysphagia.
• CPT 85025: Complete blood count (CBC) (includes differential and platelet counts): This code documents the CBC laboratory test ordered by the physician to evaluate the patient’s overall blood profile.
• CPT 80053: Comprehensive metabolic panel: This code documents the CMP laboratory test ordered by the physician to evaluate the patient’s overall metabolic function.
• CPT 84443: Assay of thyroid-stimulating hormone (TSH): This code is used to document the TSH lab test ordered by the physician to evaluate the patient’s thyroid function.
• CPT 80061: Lipid panel: This code is used to document the lipid panel laboratory test, which is part of the cardiac profile ordered by the physician to assess the patient’s cholesterol levels and heart health.
• CPT 71260: Computed tomography, thorax, with contrast material(s): This code is used to document the CT scan of the patient’s chest ordered by the physician.
• CPT 74176: Computed tomography, abdomen and pelvis; without contrast material: This code is used to document the CT scan of the patient’s abdomen and pelvis ordered by the physician.
• CPT 71550: Magnetic resonance (e.g., MRI), chest (including myocardium, if performed); without contrast material(s): This code is used to document the MRI of the patient’s chest ordered by the physician.

ICD-10 Codes:

• ICD 10 E05.90: Thyrotoxicosis without thyrotoxic crisis or storm, unspecified: This code documents the patient’s diagnosis of hyperthyroidism, confirmed by the diagnostic tests.
• ICD 10 I10: Essential (primary) hypertension: This code documents the patient’s heart-related disease.
• ICD 10 R07.2: Precordial pain: This code documents the patient’s chest pain.
• ICD 10 R00.0: Tachycardia, unspecified: This code documents the patient’s rapid heartbeat.
• ICD 10 F41.9: Anxiety disorder, unspecified: This code documents the patient’s anxiety issues.
• ICD 10 R13.10: Dysphagia, unspecified: This code documents the patient’s dysphagia.
• ICD 10 R63.4: Abnormal weight loss: This code documents the patient’s sudden weight loss.