Hyperthyroidism icd 10

Hyperthyroidism icd 10 DEFAULT

E - ICD 10 Diagnosis Code - Disorder of thyroid, unspecified - Market Size, Prevalence, Incidence, Quality Outcomes, Top Hospitals & Physicians


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Key Statistics Related to E - Disorder of thyroid, unspecified

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*Readmission Rate is calculated from Oct to Aug and all other Quality Outcomes are calculated from Oct to Sep

E - Disorder of thyroid, unspecified - as a primary diagnosis codeE - Disorder of thyroid, unspecified - as a primary or secondary diagnosis code
OUTCOMES
Avg. LOS
Readmission Rate (%)
Unplanned Readmission Rate (%)
Mortality Rate (%)
SNF Discharge Rate (%)
Home Discharge Rate (%)
PAYMENTS AND CHARGES
Total Medicare Payments
Payment Per Day
Payment Per Hospitalization
Total Medicare Charges
Avg. Charges
MARKET SIZING & INCIDENCE RATES
Total National Projected Hospitalizations - Annualized (Present on Admission - All)
Total Medicare Hospitalizations - Oct to Sep (Present on Admission - All)
Total National Projected Hospitalizations - Annualized (Present on Admission - Yes)
Total Medicare Hospitalizations - Oct to Sep (Present on Admission - Yes)
Total National Projected Hospitalizations - Annualized (Present on Admission - Not Y)
Total Medicare Hospitalizations - Oct to Sep (Present on Admission - Not Y)
Total Medicare Hospitalizations after Exclusion

Top DRGs Associated With E - Disorder of thyroid, unspecified - as a primary diagnosis code

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Top 1 to 5 DRGs - Oct to Sep

*Readmission Rate is calculated from Oct to Aug and all other Quality Outcomes are calculated from Oct to Sep

DRG THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT COMPLICATION OR COMORBIDITY (CC)/MAJOR COMPLICATION OR COMORBIDITY (MCC) DRG ENDOCRINE DISORDERS WITH COMPLICATION OR COMORBIDITY (CC) DRG ENDOCRINE DISORDERS WITHOUT COMPLICATION OR COMORBIDITY (CC)/MAJOR COMPLICATION OR COMORBIDITY (MCC) DRG ENDOCRINE DISORDERS WITH MAJOR COMPLICATION OR COMORBIDITY (MCC) DRG THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH COMPLICATION OR COMORBIDITY (CC)
Total Hospitalizations at DRG6,
Total Hospitalizations with ICD E - Disorder of thyroid, unspecified50
DRG Share of Total Hospitalizations
% of Total ICD E - Disorder of thyroid, unspecified in DRG
Avg LOS at DRG
Avg LOS with ICD E - Disorder of thyroid, unspecified
Readmission Rate at DRG
Readmission Rate with ICD E - Disorder of thyroid, unspecifiedNA
Unplanned Readmission Rate at DRG
Unplanned Readmission Rate with ICD E - Disorder of thyroid, unspecifiedNA
Total Medicare payments at DRG$30,,
Total Medicare payments with ICD E - Disorder of thyroid, unspecified$,
Total Medicare payment per Day at DRG$3,
Total Medicare payment per Day with ICD E - Disorder of thyroid, unspecified$4,
Total Medicare payment per Hospitalization at DRG$4,
Total Medicare payment per Hospitalization with ICD E - Disorder of thyroid, unspecified$5,
Total Medicare Charges at DRG$,,
Total Medicare Charges with ICD E - Disorder of thyroid, unspecified$2,,
Avg Charges at DRG$41,
Avg Charges with ICD E - Disorder of thyroid, unspecified$43,
Mortality Rate at DRGNA
Mortality Rate with ICD E - Disorder of thyroid, unspecifiedNA
SNF Discharge Rate at DRG
SNF Discharge Rate with ICD E - Disorder of thyroid, unspecifiedNA
Home Discharge Rate at DRG
Home Discharge Rate with ICD E - Disorder of thyroid, unspecified

Top DRGs Associated With E - Disorder of thyroid, unspecified - as a primary or secondary diagnosis code

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Top 1 to 5 DRGs - Oct to Sep

*Readmission Rate is calculated from Oct to Aug and all other Quality Outcomes are calculated from Oct to Sep

DRG MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC)DRG SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MAJOR COMPLICATION OR COMORBIDITY (MCC)DRG PSYCHOSESDRG HEART FAILURE AND SHOCK WITH MAJOR COMPLICATION OR COMORBIDITY (MCC)DRG ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC)
Total Hospitalizations at DRG1,,
Total Hospitalizations with ICD E - Disorder of thyroid, unspecified10,
DRG Share of Total Hospitalizations
% of Total ICD E - Disorder of thyroid, unspecified in DRG
Avg LOS at DRG
Avg LOS with ICD E - Disorder of thyroid, unspecified
Readmission Rate at DRG
Readmission Rate with ICD E - Disorder of thyroid, unspecified
Unplanned Readmission Rate at DRG
Unplanned Readmission Rate with ICD E - Disorder of thyroid, unspecified
Total Medicare payments at DRG$17,,,
Total Medicare payments with ICD E - Disorder of thyroid, unspecified$,,
Total Medicare payment per Day at DRG$4,
Total Medicare payment per Day with ICD E - Disorder of thyroid, unspecified$4,
Total Medicare payment per Hospitalization at DRG$11,
Total Medicare payment per Hospitalization with ICD E - Disorder of thyroid, unspecified$11,
Total Medicare Charges at DRG$91,,,
Total Medicare Charges with ICD E - Disorder of thyroid, unspecified$,,
Avg Charges at DRG$60,
Avg Charges with ICD E - Disorder of thyroid, unspecified$60,
Mortality Rate at DRG
Mortality Rate with ICD E - Disorder of thyroid, unspecifiedNA
SNF Discharge Rate at DRG
SNF Discharge Rate with ICD E - Disorder of thyroid, unspecified
Home Discharge Rate at DRG
Home Discharge Rate with ICD E - Disorder of thyroid, unspecified

Top 5 to 10 DRGs - Oct to Sep

*Readmission Rate is calculated from Oct to Aug and all other Quality Outcomes are calculated from Oct to Sep

DRG KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC)DRG CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MAJOR COMPLICATION OR COMORBIDITY (MCC)DRG SPINAL FUSION EXCEPT CERVICAL WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC)DRG MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIESDRG PULMONARY EDEMA AND RESPIRATORY FAILURE
Total Hospitalizations at DRG,
Total Hospitalizations with ICD E - Disorder of thyroid, unspecified1,
DRG Share of Total Hospitalizations
% of Total ICD E - Disorder of thyroid, unspecified in DRG
Avg LOS at DRG
Avg LOS with ICD E - Disorder of thyroid, unspecified
Readmission Rate at DRG
Readmission Rate with ICD E - Disorder of thyroid, unspecified
Unplanned Readmission Rate at DRG
Unplanned Readmission Rate with ICD E - Disorder of thyroid, unspecified
Total Medicare payments at DRG$2,,,
Total Medicare payments with ICD E - Disorder of thyroid, unspecified$7,,
Total Medicare payment per Day at DRG$1,
Total Medicare payment per Day with ICD E - Disorder of thyroid, unspecified$1,
Total Medicare payment per Hospitalization at DRG$4,
Total Medicare payment per Hospitalization with ICD E - Disorder of thyroid, unspecified$4,
Total Medicare Charges at DRG$11,,,
Total Medicare Charges with ICD E - Disorder of thyroid, unspecified$39,,
Avg Charges at DRG$24,
Avg Charges with ICD E - Disorder of thyroid, unspecified$22,
Mortality Rate at DRG
Mortality Rate with ICD E - Disorder of thyroid, unspecifiedNA
SNF Discharge Rate at DRG
SNF Discharge Rate with ICD E - Disorder of thyroid, unspecified
Home Discharge Rate at DRG
Home Discharge Rate with ICD E - Disorder of thyroid, unspecified

Top 10 to 15 DRGs - Oct to Sep

*Readmission Rate is calculated from Oct to Aug and all other Quality Outcomes are calculated from Oct to Sep

DRG RENAL FAILURE WITH COMPLICATION OR COMORBIDITY (CC)DRG SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC)DRG SIMPLE PNEUMONIA AND PLEURISY WITH COMPLICATION OR COMORBIDITY (CC)DRG SIMPLE PNEUMONIA AND PLEURISY WITH MAJOR COMPLICATION OR COMORBIDITY (MCC)DRG HEART FAILURE AND SHOCK WITH COMPLICATION OR COMORBIDITY (CC)
Total Hospitalizations at DRG,
Total Hospitalizations with ICD E - Disorder of thyroid, unspecified1,
DRG Share of Total Hospitalizations
% of Total ICD E - Disorder of thyroid, unspecified in DRG
Avg LOS at DRG
Avg LOS with ICD E - Disorder of thyroid, unspecified
Readmission Rate at DRG
Readmission Rate with ICD E - Disorder of thyroid, unspecified
Unplanned Readmission Rate at DRG
Unplanned Readmission Rate with ICD E - Disorder of thyroid, unspecified
Total Medicare payments at DRG$2,,,
Total Medicare payments with ICD E - Disorder of thyroid, unspecified$7,,
Total Medicare payment per Day at DRG$1,
Total Medicare payment per Day with ICD E - Disorder of thyroid, unspecified$1,
Total Medicare payment per Hospitalization at DRG$5,
Total Medicare payment per Hospitalization with ICD E - Disorder of thyroid, unspecified$5,
Total Medicare Charges at DRG$12,,,
Total Medicare Charges with ICD E - Disorder of thyroid, unspecified$34,,
Avg Charges at DRG$28,
Avg Charges with ICD E - Disorder of thyroid, unspecified$24,
Mortality Rate at DRG
Mortality Rate with ICD E - Disorder of thyroid, unspecifiedNA
SNF Discharge Rate at DRG
SNF Discharge Rate with ICD E - Disorder of thyroid, unspecified
Home Discharge Rate at DRG
Home Discharge Rate with ICD E - Disorder of thyroid, unspecified

Top 15 to 20 DRGs - Oct to Sep

*Readmission Rate is calculated from Oct to Aug and all other Quality Outcomes are calculated from Oct to Sep

DRG INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH COMPLICATION OR COMORBIDITY (CC) OR TPA IN 24 HOURSDRG MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM , FLUIDS AND ELECTROLYTES WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC)DRG G.I. HEMORRHAGE WITH COMPLICATION OR COMORBIDITY (CC)DRG CELLULITIS WITHOUT MAJOR COMPLICATION OR COMORBIDITY (MCC)DRG KIDNEY AND URINARY TRACT INFECTIONS WITH MAJOR COMPLICATION OR COMORBIDITY (MCC)
Total Hospitalizations at DRG,
Total Hospitalizations with ICD E - Disorder of thyroid, unspecified1,
DRG Share of Total Hospitalizations
% of Total ICD E - Disorder of thyroid, unspecified in DRG
Avg LOS at DRG
Avg LOS with ICD E - Disorder of thyroid, unspecified
Readmission Rate at DRG
Readmission Rate with ICD E - Disorder of thyroid, unspecified
Unplanned Readmission Rate at DRG
Unplanned Readmission Rate with ICD E - Disorder of thyroid, unspecified
Total Medicare payments at DRG$2,,,
Total Medicare payments with ICD E - Disorder of thyroid, unspecified$7,,
Total Medicare payment per Day at DRG$1,
Total Medicare payment per Day with ICD E - Disorder of thyroid, unspecified$1,
Total Medicare payment per Hospitalization at DRG$6,
Total Medicare payment per Hospitalization with ICD E - Disorder of thyroid, unspecified$6,
Total Medicare Charges at DRG$13,,,
Total Medicare Charges with ICD E - Disorder of thyroid, unspecified$38,,
Avg Charges at DRG$36,
Avg Charges with ICD E - Disorder of thyroid, unspecified$33,
Mortality Rate at DRG
Mortality Rate with ICD E - Disorder of thyroid, unspecified
SNF Discharge Rate at DRG
SNF Discharge Rate with ICD E - Disorder of thyroid, unspecified
Home Discharge Rate at DRG
Home Discharge Rate with ICD E - Disorder of thyroid, unspecified

Top Hospitals Associated With E - Disorder of thyroid, unspecified - as a primary or secondary diagnosis code

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Top Operating Physicians Associated With E - Disorder of thyroid, unspecified - as a primary or secondary diagnosis code

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Top Attending Physicians Associated With E - Disorder of thyroid, unspecified - as a primary or secondary diagnosis code

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Machine Learning Identified Top 50 Most Common Comorbid Conditions Associated With E - Disorder of thyroid, unspecified   |  Back to Top


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February 14,

Coding for Thyroid Diseases
For The Record
Vol. 23 No. 3 P. 27

The thyroid gland, which is located at the base of the neck, releases hormones that regulate all aspects of metabolism. The following are some common diseases that may occur if the thyroid is not functioning properly.

Hypothyroidism
Hypothyroidism occurs if the thyroid does not produce enough hormones. Common signs and symptoms of hypothyroidism include fatigue; weakness; weight gain; coarse, dry hair; dry, rough, pale skin; hair loss; intolerance to the cold; muscle cramps; constipation; depression; irritability; memory loss; abnormal menstrual cycles; and decreased libido.

The signs and symptoms may vary widely depending on the severity of hormone deficiency. If hypothyroidism goes untreated, it may lead to an enlarged thyroid (goiter). Very severe, advanced hypothyroidism, which can be life threatening, is called myxedema.

Hypothyroidism is classified to ICDCM category A fourth digit is required to identify the specific type of hypothyroidism as follows:

• , Postsurgical hypothyroidism;

• , Other postablative hypothyroidism, including hypothyroidism following therapy such as irradiation;

• , Iodine hypothyroidism;

• , Other iatrogenic hypothyroidism;

• , Other specified acquired hypothyroidism, including secondary hypothyroidism; and

• , Unspecified hypothyroidism.

Hypothyroidism is diagnosed primarily based on the amount of thyroid hormone measured in the blood. Hypothyroidism is treated with the synthetic thyroid hormone levothyroxine (Levothroid, Synthroid), which restores adequate hormone levels.

Hyperthyroidism
In hyperthyroidism, the thyroid gland produces too much of the thyroid hormone and accelerates the body’s metabolism. Common signs and symptoms of hyperthyroidism include heart palpitations, increased heart rate, intolerance to heat, nervousness, insomnia, breathlessness, increased bowel movements, light or absent menstrual periods, fatigue, trembling hands, weight loss, muscle weakness, hair loss, and warm, moist skin.

Hyperthyroidism is classified to category , with a fourth digit required to identify the specific type of disease such as the following:

• , Toxic diffuse goiter, including Basedow’s disease, Exophthamic or toxic goiter, Graves’ disease, and primary thyroid hyperplasia;

• , Toxic uninodular goiter;

• , Toxic multinodular goiter;

• , Toxic nodular goiter, unspecified;

• , Thyrotoxicosis from ectopic thyroid nodule;

• , Thyrotoxicosis of other specified origin; and

• , Thyrotoxicosis without mention of goiter or other cause.

In addition, a fifth-digit subclassification is required with category as follows:

• 0 — without mention of thyrotoxic crisis or storm; and

• 1 — with mention of thyrotoxic crisis or storm.

A thyroid storm is a sudden, extreme overactivity of the thyroid gland. It may produce a fever, extreme weakness, mood swings, confusion, altered consciousness, coma, and enlarged liver with jaundice. It may be life threatening if not treated emergently.

Treatment for hyperthyroidism may include one or more of the following: radioactive iodine, antithyroid medications such as propylthiouracil and methimazole (Tapazole), beta-blockers to reduce rapid heart rate and prevent palpitations, and surgery such as thyroidectomy.

Thyroid Goiter
A nontoxic goiter is an enlargement of the thyroid that is not associated with the overproduction of thyroid hormone or malignancy. Nontoxic nodular goiter is classified to category A fourth-digit subcategory is required to specify the type of goiter as follows:

• , Nontoxic uninodular goiter;

• , Nontoxic multinodular goiter; and

• , Unspecified nontoxic nodular goiter.

Category identifies simple and unspecified goiter with the fourth-digit subcategory as follows:

• , Goiter, specified as simple; and

• , Goiter, unspecified.

Toxic goiters are classified to category and were discussed under the hyperthyroidism section.

Graves’ Disease
Also called diffuse toxic goiter, Graves’ disease (x) is the most common form of hyperthyroidism. It is an autoimmune disorder in which the immune system attacks the thyroid gland and causes it to overproduce thyroxine, a thyroid hormone. The signs and symptoms are the same as hyperthyroidism with three additional characteristic symptoms: goiter, bulging eyes (exophthalmos), and raised areas of skin over the shins.

Hashimoto’s Disease
Hashimoto’s disease () is an autoimmune disorder that causes inflammation of the thyroid gland and often leads to hypothyroidism. Also called autoimmune thyroiditis and chronic lymphocytic thyroiditis, the signs and symptoms for Hashimoto’s disease are the same as hypothyroidism.

Thyroid Nodules
Thyroid nodules are abnormal growths or lumps in the thyroid gland. The nodules may be solid or fluid filled and benign or malignant. Benign nodules are the most common and may cause no symptoms. Malignant nodules may not cause any signs or symptoms in the early stages but may cause the following as the cancer grows: a lump just below the Adam’s apple, hoarseness, difficulty swallowing or breathing, swollen lymph nodes in the neck, pain in the throat or neck, and symptoms of hyperthyroidism or hypothyroidism.

Thyroid nodules are classified to ICDCM code , Nontoxic uninodular goiter. If the thyroid nodule occurs with hyperthyroidism or thyrotoxicosis, assign code x. A fifth-digit subclassification is needed to identify presence or absence of thyrotoxic crisis or storm. Benign neoplasm of the thyroid gland is classified to code Malignancy of the thyroid gland is assigned to code

Coding and sequencing for thyroid diseases are dependent on the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICDCM and American Medical Association CPT Assistant references to ensure complete and accurate coding.

— This information was prepared by Audrey Howard, RHIA, of 3M Consulting Services. 3M Consulting Services is a business of 3M Health Information Systems, a supplier of coding and classification systems to more than 5, healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payers as the result of the misuse of this coding information. More information about 3M Health Information Systems is available at www.3mhis.com or by calling

 

Coding for Thyroid Diseases in ICDCM
In ICDCM, disorders of the thyroid gland are classified to categories E00 to E The categories are as follows:

• E00, Congenital iodine-deficiency syndrome;

• 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; and

• E07, Other disorders of thyroid.

Currently, the coding directives related to thyroid diseases are the same in ICDCM as in ICDCM, although some conditions are classified to different chapters or different blocks. For example, in ICDCM, postsurgical hypothyroidism is classified to code , which is in the hypothyroidism category. However, in ICDCM, postsurgical hypothyroidism is not located under category E03, Other hypothyroidism. Instead, it is classified to code E Category E89 is titled “Postprocedural endocrine and metabolic complications and disorders, not elsewhere classified.”

— Audrey Howard

Sours: https://www.fortherecordmag.com/archives/pshtml
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icd10 - E Thyrotoxicosis with diffuse goiter without thyrotoxic crisis or storm

categoryCode : E05

diagnosisCode : 00

fullCode : E

abbreviatedDescription : Thyrotoxicosis w diffuse goiter w/o thyrotoxic crisis

fullDescription : Thyrotoxicosis with diffuse goiter without thyrotoxic crisis or storm

categoryTitle : Thyrotoxicosis [hyperthyroidism]

billable : billable

FHIR Resource for ICD icd10E Thyrotoxicosis with diffuse goiter without thyrotoxic crisis or storm

{ "identifier": [ { "system": "http://hl7.health/dev/fhir/doc/extension/DataTypeCoding/icd" } ], "code": "E", "system": "http://hl7.org/fhir/sid/icdcm", "display": "E,Thyrotoxicosis w diffuse goiter w/o thyrotoxic crisis", "id": "icd10E", "version": "", "resourceType": "DataTypeCoding" }
Home pageSours: https://1up.health/health-data/icd10/id/E
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Disease definition

A rare ophthalmic disorder characterized by clinical signs of Graves orbitopathy (i. e. unilateral or bilateral lid retraction, exophthalmos, soft tissue involvement, restrictive myopathy, and/or optic neuropathy) with normal thyroid function and without any signs of hyperthyroidism. Laboratory examination typically reveals low serum levels of thyroid-stimulating hormone receptor autoantibodies.

ORPHA

Classification level: Disorder
  • Synonym(s):
    • Euthyroid Graves ophthalmopathy
  • Prevalence: -
  • Inheritance: Not applicable 
  • Age of onset: -
  • ICD H
  • OMIM: -
  • UMLS: -
  • MeSH: -
  • GARD: -
  • MedDRA: -

Additional information

Further information on this disease

Patient-centred resources for this disease

Research activities on this disease

Specialised Social Services

The documents contained in this web site are presented for information purposes only. The material is in no way intended to replace professional medical care by a qualified specialist and should not be used as a basis for diagnosis or treatment.
Sours: https://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=EN&Expert=

Icd 10 hyperthyroidism

Disease entity

Cat Nguyen Burkat, MD FACS,&#;K. David Epley, M.D.,&#;Paul O. Phelps, MD, FACS,&#;Rona Z Silkiss, MD FACS,&#;Vikram D. Durairaj, MD,&#;Brad H. Feldman, M.D.,&#;Paul O. Phelps, MD, FACS,&#;Guy V. Jirawuthiworavong, M.D., M.A.,&#;Dr. Rashmin Gandhi FRCS (Edin.) FRCS (Glasg.),&#;Nagham Al-Zubidi, MD,&#;Sudha Nallasamy, MD,&#;Michael T Yen, MD,&#;Sezen Karakus, MD,&#;Harkaran S. Rana D.O.,&#;Preeti Thyparampil, MD,&#;Marcus M. Marcet, MD

Assigned status Up to Date

&#;by Nagham Al-Zubidi, MDon July 11,

Disease

Thyroid eye disease (TED) is an autoimmune disease caused by the activation of orbital fibroblasts by autoantibodies directed against thyroid receptors. TED is a rare disease, which had an incidence rate of approximately 19 in , people per year in one study.[1] The disorder characterized by enlargement of the extraocular muscles, fatty and connective tissue volume. Graves' disease&#;(GD) is an autoimmune disorder involving the&#;thyroid gland, typically characterized by the presence of circulating&#;autoantibodies&#;that bind to and stimulate the&#;thyroid hormone receptor&#;(TSHR), resulting in&#;hyperthyroidism&#;and&#;goiter. Organs other than the thyroid can also be affected, leading to the extrathyroidal (outside the thyroid gland itself) manifestations of GD. TED is observed in ~&#;50% of patients while Graves'&#;dermopathy&#;and acropachy are quite rare.[2]&#;TED was previously known as thyroid-associated ophthalmopathy (TAO), Graves orbitopathy (GO) and other variations.

Etiology

TED is most frequently associated with Hyperthyroidism, consisting of approximately 90% of the cases. However about 10% of patients with TED have either a normal-functioning (Euthyroid) or under-functioning thyroid (Hypothyroidism e.g. Hashimoto's thyroiditis) . While strict control of thyroid function is crucial in patients with TED, the course and severity of ocular manifestation does not always correlate with thyroid hormone levels. Thus, treatment of thyroid dysfunction does not necessarily affect course of Grave’s ophthalmopathy.

Risk Factors

Include genetic, environmental, and immune factors. Among the environmental factors, smoking is the most consistently linked risk factor to the development or worsening of the disease.[3] Stress is another environmental factor which may contribute to the worsening of TED.[4] Patients treated with radioactive iodine may experience worsening of TED, especially if they are smokers.[2]

Epidemiology

TED has a higher prevalence in women than men. Both men and women demonstrate a bimodal pattern of age of diagnosis. The median age is 43 years for all patients, with a range from 8 to 88 years old. Patients diagnosed over 50 -year have worse prognosis overall.[1]

Pathophysiology

Although the underlying mechanisms of action of these processes are not completely understood, the presumed mechanism is activation of orbital fibroblasts by Graves' disease-related autoantibodies, which lead to the release of T cell chemoattractants, initiating an interaction which ultimately results in fibroblasts expressing extracellular matrix molecules, biologic materials proliferating and differentiating into myofibroblasts or lipofibroblasts and deposition of glycosaminoglycans which bind water that lead to swelling, congestion in addition to connective tissue remodeling. This results in extraocular muscle enlargement and orbital fat expansion.

History/Symptoms

The patient complains of gritty sensations, photophobia, lacrimation, dry eye, discomfort, and forward protrusion of the eye. In more advanced cases, patient may complain eye socket (orbital) pain, double vision, or blurred vision.

Signs

Exophthalmos noted in axial view of CT-scan. Patient with TED also demonstrates enlargement of extra ocular muscles (asterisk).
Eyelid retraction in patient with TED. Upper lid retraction measured with margin to reflex distance 1 (MRD1) and lower lid retraction measured with margin to reflex distance 2 (MRD2).
  1. Eyelid retraction (Dalrymple's sign) is the most common presenting sign of TED, present in upto 90% of patients.[5]
  2. Lid lag of the upper eyelid on downward gaze ( Von Graefe’s sign) and lid edema.[6]
  3. TED is the most common cause for both unilateral and bilateral axial proptosis (exophthalmos). There is increased resistance to retropulsion. Hertel’s exophthalmometer is used for the measurement of proptosis.
  4. Bulbar conjunctiva may be injected (Goldzeiher’s sign). Exposure keratopathy ocular emergency can occur further due to lagophthalmos, which is a major cause for decrease visual acuity and blurred vision in TAO apart from compressive optic neuropathy.
  5. Extraocular muscles frequently involved in TAO. The most commonly affected muscle Mnemonic “I'M SLOw” Inferior rectus followed by medial, superior, levator, lateral rectus and oblique. Extraocular muscles affected results in ocular misalignment, diplopia. Inability to look up when the eye is adducted i.e. double elevator palsy.
  6. Compressive optic neuropathy is an ocular emergency, and occurs in <5% of patients with typical TED resulting in slowly progressive fulminant visual loss. It occurs due to compression from the oversized recti and orbital fat causing compartment syndrome at the apex of orbit. It is characterized by decrease in vision, color vision, contrast sensitivity and relative afferent papillary defect. The characteristic visual fields commonly show central, cecocentral, paracentral, and nerve fiber layer bundle defects. Optic nerve head examination can be normal, optic disc edema, or pallor.
  7. Clinical course: TED typically has a progressive inflammatory phase followed by a stable post-inflammatory phase.
  8. The pattern of the disease follow the Rundle’s curve which describe the plot of orbital disease severity against time
    • Initial phase- inflammatory phase duration may last from 6 – 18 months with orbital and periorbital signs i.e. proptosis and retraction.
    • Static phase- decrease in the inflammatory phase and minimal improvement.
    • Quiescent phase- gradual improvement with improved motility and retraction of the muscles

Diagnostic procedures

Laboratory test

The diagnosis can be done clinically with the characteristic clinical picture, restrictive nature of the disease and associated systemic thyroid disease. Though not diagnostic, thyroid hormone levels, thyroid-stimulating immunoglobulins (TSI), anti thyroid antibodies can be suggestive of diagnosis.

Ultrasonography: Both A-scan and B-scan transocular echograms can be used to visualize the orbital structures and determining recti muscle enlargement. Advantage is its low cost, lack of ionizing radiation and relatively short examination time

Imaging

Computed tomography (CT) scan: This type of imaging without contrast may distinguish normal structures from abnormal structures of different tissue density. It demonstrates enlargement of the bellies and sparing of the tendons. It helps in assessing the relationship between the optic nerve and muscles at the apex, which helps in planning for the surgical intervention if needed.

Magnetic resonance imaging (MRI): Fusiform rectus enlargement and orbital fat expansion may be identified. MRI may also aide in assessing water content in the muscles and other soft tissues. This may correlate with active inflammation.

Differential diagnosis

  • Orbital pseudotumour
  • Caroticocavernous fistula
  • Inflammatory orbitopathy e.g, granulomatosis with polyangitis
  • Orbital myositis (OM)
  • Orbital tumors
  • IgG4 disease

Grading

Werner reported the NO SPECS (Nophysical signs or symptoms, Only signs, Soft tissue involvement, Proptosis, Extraocular muscle signs, Corneal involvement, and Sight loss) Classification system in and a modified version was published in What’s worth noting is that this system grades on disease severity and not the activity of the disease.

A shift in treatment began in when the Clinical Activity Score (CAS) was created to help distinguish the active and stable phases of the disease- its distinguishing feature is grading classic signs of acute inflammation. A CAS ≥3/7 is indicative of active disease.

The most current grading systems of TED are the VISA (vision, inflammation, strabismus, and appearance) classification and the European Group of Graves' Orbitopathy (EUGOGO) classification [7]. The utility of these grading systems is that both assess severity and activity.

In the VISA classification, the 4 severity parameters can be found in the name, and a maximum score of 20 is used to grade the severity of disease. Each of the four parameters has further divisions in order to better asses the activity of the disease; the form can be found at (http://www.thyroideyedisease.org).

EUGOGO Classification of Thyroid Eye Disease (TED) disease severity

EUGOGO classification attempts to assess both disease activity and disease severity. Activity is based on four measures of inflammation, pain, redness, swelling, and impaired function, and function is graded with decreasing monocular motion and diminishing visual acuity. The classification system also has developed an image atlas which can be used to accurately grade the patient in front of you. Additionally, the EUGOGO grading system does well in differentiating management categories[8].&#;

Conservative: Both smoking cessation and euthyroid status help preventing further exacerbation and decrease the duration of active disease.[9] For corneal exposure, lubricants, taping and protective shields can be tried and if necessary tarsorrhapphy can be done. For diplopia, Fresnel prisms or occlusion therapy may be considered. Others are lifestyle modifications e.g. sodium restriction to reduce water retention and tissue edema. Sleeping with the head of the bed elevated to decrease orbital edema. Oral NSAIDs may be used for periocular pain. Selenium has shown significant benefit in patients with mild, non‐inflammatory orbitopathy.[10]

Teprotumumab: This biologic infusion therapy has been shown in clinical studies to reduce signs and symptoms of TED.[11][12] Teprotumumab binds to IGF-1R and blocks its activation and signaling. Tepezza (Teprotumumab-trbw) is the first and only FDA-approved prescription treatment for TED.

Systemic steroids: To decrease orbital inflammation oral prednisone in a dose of 1- mg/ kg can be given for a suggested maximum period of 2 months. Intravenous (IV) corticosteroids pulse methyl prednisolone can be considered as an alternative.

Orbital Radiation: Can be used alone or in conjunction with corticosteroids The radiation therapy works on the similar mechanism of decreasing inflammation. Typical dose of cGy for each orbit cGy / day given over a period 10 days. It generally improves vertical motility. Radiation retinopathy may occur as a side effect.

Orbital Decompression: This surgical procedure enlarges the existing space of the orbit by partial removal of bony walls. Orbital decompression commonly involves the orbital floor, medial wall, and lateral wall. In rare cases the roof of the orbit may also be decompressed surgically.

Strabismus surgery: In cases of significant strabismus, strabismus surgery may be required and should be done with adjustable sutures since the muscles typically do not respond as normal muscles would to strabismus surgery. Strabismus surgery should be considered only after orbital decompression is complete and muscle alignment has stabilized.

Eyelid Retraction Repair and Tarsorrhaphy&#;: These reconstructive surgical procedures may be preformed to address eyelid retraction or exposure keratitis.

Alternative Treatments: Rituximab is a monoclonal antibody that targets CD‐20 on B‐cells[13][14]

  1. Bartley, G. B. (). The epidemiologic characteristics and clinical course of ophthalmopathy associated with autoimmune thyroid disease in Olmsted County, Minnesota.&#;Transactions of the American Ophthalmological Society,&#;92,
  2. Menconi, F., Marcocci, C., & Marinò, M. (). Diagnosis and classification of Graves' disease.&#;Autoimmunity reviews,&#;13(),
  3. ↑Thornton, J., Kelly, S. P., Harrison, R. A., & Edwards, R. (). Cigarette smoking and thyroid eye disease: a systematic review.&#;Eye,&#;21(9),
  4. ↑Mizokami, T., Wu Li, A., El-Kaissi, S., & Wall, J. R. (). Stress and thyroid autoimmunity.&#;Thyroid,&#;14(12),
  5. ↑Phelps PO, Williams K. Thyroid Eye Disease for the Primary Care &#;Practitioner. Disease-a-Month 60()– [PMID &#;]
  6. ↑Principles and practice of Ophthalmogy; Albert and jakobiec’s by Albert D M, Miller J W; 3rd edition- chapter page

  7. Barrio-Barrio J, Sabater AL, Bonet-Farriol E, Velázquez-Villoria Á, Galofré JC. Graves' Ophthalmopathy: VISA versus EUGOGO Classification, Assessment, and Management. J Ophthalmol. ; doi: // Epub Aug PMID: ; PMCID: PMC
  8. ↑Bartalena L, Baldeschi L, Dickinson A, Eckstein A, Kendall-Taylor P, Marcocci C, Mourits M, Perros P, Boboridis K, Boschi A, Currò N, Daumerie C, Kahaly GJ, Krassas GE, Lane CM, Lazarus JH, Marinò M, Nardi M, Neoh C, Orgiazzi J, Pearce S, Pinchera A, Pitz S, Salvi M, Sivelli P, Stahl M, von Arx G, Wiersinga WM; European Group on Graves' Orbitopathy (EUGOGO). Consensus statement of the European Group on Graves' orbitopathy (EUGOGO) on management of GO. Eur J Endocrinol. Mar;(3) doi: /EJE PMID:
  9. ↑Bartalena L, Pinchera A, Marcocci C. Management of Graves' ophthalmopathy: reality andperspectives. Endocr Rev ;21(2)‐ [PMID ]
  10. ↑Drutel, A., Archambeaud, F., & Caron, P. (). Selenium and the thyroid gland: more good news for clinicians.&#;Clinical endocrinology,&#;78(2),
  11. ↑Douglas, R. S., Kahaly, G. J., Patel, A., Sile, S., Thompson, E. H., Perdok, R., & Antonelli, A. (). Teprotumumab for the treatment of active thyroid eye disease.&#;New England Journal of Medicine,&#;(4),
  12. ↑Smith, T. J., Kahaly, G. J., Ezra, D. G., Fleming, J. C., Dailey, R. A., Tang, R. A., & Gigantelli, J. W. (). Teprotumumab for thyroid-associated ophthalmopathy.&#;New England Journal of Medicine,&#;(18),
  13. ↑Stan MN, Garrity JA, Carranza Leon BG, Prabin T, Bradley EA, Bahn RS. Randomized controlled trial of rituximab in patients with Graves' orbitopathy. J Clin Endocrinol Metab ;(2)‐ [PMID ]
  14. ↑Silkiss RZ, Reier A, Coleman M, Lauer SA. Rituximab for thyroid eye disease. Ophthal Plast Reconstr Surg ;26(5)‐ [PMID ]
Sours: https://eyewiki.aao.org/Thyroid_Eye_Disease
ICD-10-CM Coding Demonstration using Neoplasm Table
E02Subclinical iodine-deficiency hypothyroidismTYYNE03Other hypothyroidismFYNNECongenital hypothyroidism with diffuse goitreTYYNECongenital hypothyroidism without goitreTYYNEHypothyroidism due to medicaments and other exogenous substancesTYYNEPostinfectious hypothyroidismTYYNEAtrophy of thyroid (acquired)TYYNEMyxoedema comaTYYNEHypothyroidism from Hashimoto’s thyroiditis (TM)TYYNEOther specified hypothyroidismTYYNEHypothyroidism, unspecifiedTYYNE04Other nontoxic goitreFYNNENontoxic diffuse goitreTYYNENontoxic single thyroid noduleTYYNENontoxic multinodular goitreTYYNEOther specified nontoxic goitreTYYNENontoxic goitre, unspecifiedTYYNE05Thyrotoxicosis [hyperthyroidism]FYNNEThyrotoxicosis with diffuse goitreTYYNEThyrotoxicosis with toxic single thyroid noduleTYYN
Sours: http:///datacheck/frontend/web/index.php?r=icd10%2Findex&sort=icd10&page=

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What are ICD Codes (and Why Should I Know about Them)?

icd 10 codes

ICD codes are standardised alpha-numerical codes developed by the World Health Organisation (WHO). They're printed on all medical invoices and pinpoint exactly what disease or condition you have been diagnosed with, and are undergoing treatment for.

The structured coding system allows medical aid schemes to manage the claims process better. As there is no ambiguity surrounding the diagnosis, schemes have a clear idea of what benefits you are eligible for, and which benefit pool to pay the claim from.

How the ICD coding system works

The internationally accepted coding system consists of 22 broad groups of codes, or blocks, that are assigned a letter of the alphabet. Each block is broken down into several numbered sub-groups, many of which are split again and linked to a precise diagnosis of your disease.

As an example, diseases of the endocrine system fall within the EE90 code block; diseases of the thyroid gland fit into the EE07 sub-group; hyperthyroidism is denoted as E05, Graves’ disease as E, and a thyroid storm is designated ICD code E

Why assigning the correct ICD Code is vital

To illustrate how important it is for doctors, specialists and other healthcare providers to allocate the accurate ICD code to a condition, let’s unpack the example mentioned.

If you were diagnosed with Graves’ disease, denoted by the ICD code E on the invoice, the medical aid scheme would pay for the consultation and prescribed medicine from your available day to day benefits, or medical savings account. Had these benefits been depleted, your claim would not be paid out.

However, if the ICD code on the invoice had been E, signifying the diagnosis of a thyroid storm, the medical scheme would be obliged to settle your claim in full, from risk and not savings.

Why? Hyperthyroidism “with life-threatening complications” is a prescribed minimum benefit (PMB) condition that has to, by law, be covered in full by all medical aid schemes in South Africa.

How to check ICD codes

The ICD coding system is a transparent resource allocation system used by medical aid schemes in over 25 countries. The codes, together with their corresponding diagnoses, are available online.

So before you submit an invoice, or fill in a medical aid claims form, be sure to check that the ICD code corresponds with the diagnosis the healthcare provider has given you verbally after consultation.

Now that you know what ICD codes are, and how they work, make sure you’ve got your medical expenses covered.

At IFC, we offer informed, objective advice about South African medical aid schemes and gap cover, and can assist you in joining the scheme that best suits your needs and budget. Contact us for more information or to discuss your needs.

Contact Us Now For Free Medical Aid Advice & Quotes

Sours: https://www.medicalaid-quotes.co.za/articles/what-are-icdcodes-and-why-should-i-know-about-them


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