Thyroid and Parathyroid

Cancer and Tumors of the Endocrine System

Code 7906: Thyroiditis occurs when the thyroid gland becomes irritated and swells. It can cause no symptoms at all or result in either hyperthyroidism or hypothyroidism. If it doesn't cause any symptoms, then it is rated 0% under this code. If it causes hyperthyroidism or hypothyroidism, it is rated under their respective codes.

Code 7904: Hyperparathyroidism occurs when the parathyroid gland produces too many hormones. There are two kinds of hyperparathyroidism: primary and secondary. Primary is a result of the glands themselves malfunctioning. This kind has very few symptoms but can include symptoms like depression, fatigue, bone pain, and muscle soreness. Secondary is a result of low Vitamin D levels. Symptoms include bone conditions like osteomalacia.

60% - If there is hypercalcemia (too much calcium in the blood). To qualify as hypercalcemia, one or more of the following must be present:

the total calcium level must be greater than 12 mg/dL (3-3.5 mmol/L)
the ionized calcium level greater than 5.6 mg/dL (2-2.5 mmol/L)
the creatinine clearance less than 60 mL/min
the bone mineral density T-score less than 2.5 SD (below the mean)

This 60% rating will continue for 6 months after treatment begins or until surgery is performed, if indicated. If surgery is performed, a 100% rating will be given and will continue for the first 6 months following the surgery. After the 6-month period following either surgery or other treatment, any remaining symptoms (like kidney stones, vision problems, heart problems, etc.) will be rated separately under the appropriate codes unless they are covered by the 10% rating below.

10% - If symptoms including nausea, anorexia, fatigue, or constipation are present despite surgery, or if constant medication is required to control the symptoms and surgery cannot be performed.

0% - Asymptomatic/no symptoms.

Code 7905: Hypoparathyroidism occurs when the parathyroid glands produce too few hormones. This causes low levels of calcium in the blood and can cause symptoms like cramping, muscle aches, muscle twitches, headaches, and fatigue. This condition can occur as a side effect from thyroid surgery. This condition is rated 100% for the first 3 months after diagnosis. It is then rated on any remaining symptoms, like kidney stones, cataracts, congestive heart failure, or any decrease in renal function.

Pituitary Conditions

The pituitary gland produces growth hormones. These help with initial growth and development in childhood and help with cell reproduction in adulthood.

Code 7908: Acromegaly is a condition where the pituitary gland produces too much growth hormone. This can cause severe disfigurement and gigantism.

100% - If there is pressure in the skull, which causes problems with things like vision, diseases in the joints, glucose intolerance (hyperglycemia), and either high blood pressure or swelling of the heart.

60% - If there are diseases in the joints, glucose intolerance, and high blood pressure.

30% - If there is significant over-growth in the limbs or long bones.

Adrenal Conditions

The adrenal glands produce hormones, like adrenaline, in response to stress. They also provide the kidneys a necessary hormone for filtering the blood, and they produce steroid hormones which help with the immune system, the metabolism, and sex-specific parts and functions.

Code 7911: Addison’s disease is a condition where the adrenal glands do not produce enough steroid hormones.

For this code, a “crisis” occurs if arteries and veins in the limbs collapse, and blood can no longer circulate throughout the limbs. This is accompanied by extremely low blood pressure and severe shock. Other symptoms can include nausea, vomiting, anorexia, dehydration, severe weakness, pain in the stomach, legs, and back, fever, and seriously limited brain functioning which could lead to coma and death.

Likewise, an “episode” is not as severe as a crisis. The arteries and veins do not collapse, but symptoms may include anorexia, nausea, vomiting, diarrhea, dehydration, weakness, low blood pressure, low blood sugar, and a slowing of mental functioning.

60% - If there were 4 or more crises during the past year.

40% - If there were 3 crises or 5 or more episodes during the past year.

20% - If there were 1 or 2 crises during the past year, 2 to 4 episodes during the past year, weakness and fatigability, or if corticosteroids are required to control the condition.

Multiple-Gland Conditions

Code 7912: Polyglandular syndrome (including multiple endocrine neoplasia and autoimmune polyglandular syndrome) covers any condition that affects multiple glands of the endocrine system at the same time. This condition is rated on the main symptoms it causes. So, if it causes diabetes mellitus, it is rated under code 7913. Similarly, if it causes hyperthyroidism, hypothyroidism, hypoparathyroidism, Addison’s disease, or any other condition, it is rated under that condition’s code.

Cancer and Tumors of the Endocrine System

Cancer and tumors are made up of the growth of abnormal cells. These cells can be benign—they do not destroy the good cells around them (tumors)—or they can be malignant—they destroy the cells around them (cancers). A “cancerous tumor” is just cancer under our definition.

Code 7901: Toxic thyroid enlargement occurs when a tumor forms and causes the thyroid to produce too many hormones. It is rated as hyperthyroidism under code 7900. If the enlargement of the thyroid causes disfigurement of the neck, then an additional rating can be given under code 7800.

Code 7902: Nontoxic thyroid enlargement occurs when a tumor forms, but it does not cause the thyroid to produce too many hormones. If it causes problems from pushing on the organs or bodily systems around it, then it can be rated based on the problems it causes. For example, if it pushes on the esophagus and makes it hard to swallow, then it can be rated as a stricture of the esophagus, code 7203. If it also causes disfigurement of the neck, then it can be given an additional rating under code 7800.

Code 7907: Cushing’s syndrome occurs when there is too much cortisol in the body. Symptoms include rapid weight gain, excessive sweating, bruising easily, weakness, high blood pressure, and more. This condition is most often caused by either a tumor in the pituitary gland (“Cushing’s disease”) or by the prolonged use of steroids to treat other conditions.

100% - If it is an active disease that is getting progressively worse and it causes osteoporosis, high blood pressure, and muscle wasting that makes it impossible to rise from a squatting position or a deep chair, climb stairs, or raise your arms.

60% - If it is no longer getting worse, but there is still muscle wasting that makes it impossible to rise from a squatting position or a deep chair, climb stairs, or raise your arms.

30% - If it causes obesity, a significantly round face caused by weight gain (“moon face”), stretch marks, fragile veins or arteries, and glucose intolerance (a pre-diabetic condition), it is rated 30%.

These ratings are all given for the first 6 months following diagnosis, after which time any leftover symptoms or complications are each rated separately.

Code 7916: Hyperpituitarism occurs when the pituitary gland produces too many hormones because of a tumor or a cancer. If it is caused by a cancer, it is rated under code 7914. If it is caused by a tumor, it is rated under code 7915. The final code will look like this: 7916-7914. The first four-digit code defines the condition as hyperpituitarism, and the second four-digit code tells how it is rated. If 7914 or 7915 guides the rating to another code, then that four-digit code will be added to the end of 7916.

Code 7917: Hyperaldosteronism occurs when the adrenal glands produce too many aldosterone hormones because of a tumor or a cancer. If it is caused by a cancer, it is rated under code 7914. If it is caused by a tumor, it is rated under code 7915. The final code will look like this: 7917-7914. The first four-digit code defines the condition as hyperpituitarism, and the second four-digit code tells how it is rated. If 7914 or 7915 guides the rating to another code, then that four-digit code will be added to the end of 7917.

Code 7918: Pheochromocytoma occurs when the adrenal glands produce too many noradrenaline and adrenaline hormones because of a tumor or a cancer. If it is caused by a cancer, it is rated under code7914. If it is caused by a tumor, it is rated under code 7915. The final code will look like this: 7918-7914. The first four-digit code defines the condition as hyperpituitarism, and the second four-digit code tells how it is rated. If 7914 or 7915 guides the rating to another code, then that four-digit code will be added to the end of 7918.

Code 7919: C-cell hyperplasia of the thyroid is a condition where the C-cells that produce calcitonin in the thyroid grow abnormally into a cancer. If it is treated with chemotherapy, it is rated under code 7914. If surgery is performed and chemo is not required, then it is rated under code 7903.

Code 7914: Any active cancer of the endocrine system that is not listed above is rated under this code. While it is active, it is rated 100%. This 100% rating will continue for the first 6 months after the last treatment or procedure. It is then reevaluated. If it is no longer active, then any leftover symptoms or complications are rated separately on the function they affect. So, if the symptoms affect the adrenal gland, then it is rated on the impact they have on that gland.

Code 7915: Any tumor of the endocrine system that is not listed above is rated under this code. There are no set ratings for this code. Any symptoms that the tumor causes are rated separately on the function they affect. So, if the symptoms affect the adrenal gland, then it is rated on the impact they have on that gland. The final code for any of these tumors will look like this: 7915-7100. The first four-digit code defines the condition as a tumor of the endocrine system, and the second four-digit code tells how it is rated.

Other Endocrine Conditions

All other genitourinary system conditions will be rated analogously (see the Analogous and Equivalent Codes page) with the above ratings. The bottom-line rule is to rate any condition under the code that BEST describes it, even if it is not exact.