tsh cpt code

(2022) TSH CPT Code 84443 – Description, Guidelines, Reimbursement, Modifiers & Examples

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

TSH CPT Code Description

TSH CPT code 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. 

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

cpt code for tsh

Reimbursement

A maximum of 4 units of TSH CPT code 84443 can be billed on the same date of service. The cost of CPT 84443 is as follows, and RUVS are not applicable for Pathology and laboratory procedure codes (CPT 80047- 89398):

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

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

TSH CPT Code Modifiers 

Below is a list of modifiers that are applicable with CPT 84443:

  • 52, 33, 22, 59, 58, 78, 79, 90, 91, 99, AI, CR, CC, EY, ET, XP, XS, XU, XE, QW, QP, QJ, Q6, Q5, KX, GZ, GY, GX, GJ, GK, GR, GC, GA.

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 specificity of code if billed to Medicare insurance.

Modifier 91 will be appended with TSH CPT code 84443 when it is 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 the unplanned patient return due to any complications.

cpt codes for tsh

TSH CPT Code 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 and 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 not appropriate 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 not appropriate to attach with CPT code 84443.

If CPT 8443 is done in combination 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. 

CPT 84443 Examples

The following are examples of TSH CPT code 84443 and when this service or test is billed.

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 any headache, 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 prescribed medicine for the treatment.

Example 2

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

The patient denies any 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 abdomen and pelvis, and lab tests Like TSH or CBC to confirm the diagnosis. Lab and pathology tests confirmed that the patient has hypothyroidism.

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 had reviewed the system that confirmed that the patient has digestive problems with constipation and these presenting symptoms.

The patient was eating normally and denied any sleeping disorders, dizziness, numbness, urinary symptoms, eyes, and ear problems. The physical exam revealed that 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 ultrasound of the abdomen, CTA chest, and Xray of the chest. The study shows that the patient has hypothyroidism.

Example 4

A 25-year-old male presents to the emergency department with a past medical history of thyroid cancer and no family history. For the past two weeks, the patient has had chest pain, rapid heartbeat, anxiety, and dysphagia. There is sudden weight loss detected these days, and he is unable to eat anything.

Vitals signs 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 been worsening for the last two days, and he is unable to bear chest pain.

The patient denies any tremors of both upper and lower extremities, headache, skin, urinary bladder symptoms allergies. 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.

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