Which ICD‑10 code should I use to justify ordering a thyroid‑stimulating hormone (TSH) test for a patient who reports food or something feeling stuck (dysphagia)?

ICD-10 Coding for TSH Testing in Dysphagia

Use ICD-10 code R13.10 (dysphagia, unspecified) as the primary diagnosis to justify ordering TSH, because thyroid dysfunction—both hypothyroidism and hyperthyroidism—can cause esophageal dysmotility and dysphagia that resolves with normalization of thyroid function. 1, 2, 3

Primary Diagnosis Code

• R13.10 (dysphagia, unspecified) is the appropriate code when the patient reports food feeling stuck but the specific phase of swallowing has not yet been determined. 4

• If clinical evaluation localizes the dysphagia, use more specific codes:

  • R13.12 (oropharyngeal dysphagia) if symptoms include difficulty initiating swallowing, coughing, choking, or nasal regurgitation 4
  • R13.13 (pharyngeal dysphagia) for isolated pharyngeal phase dysfunction 4
  • R13.19 (other dysphagia) for esophageal phase dysphagia 4

Clinical Justification for TSH Testing

Thyroid disease is a recognized but uncommon cause of dysphagia that must be excluded in the initial workup:

• Hashimoto disease (hypothyroidism) causes esophageal motility disorders presenting as dysphagia or heartburn through hormonal effects on esophageal neuromuscular coordination. 1, 2

• Severe hypothyroidism can cause dysphagia that resolves completely with levothyroxine treatment, even when extensive investigations reveal no obstructive cause. 2

• Hyperthyroidism (Graves' disease, thyrotoxicosis) causes myopathic dysphagia affecting both liquids and solids, with severe cases requiring G-tube placement until thyroid function normalizes. 5, 3, 6

• Dysphagia from thyrotoxicosis typically resolves within 3 weeks of anti-thyroid treatment on average, though severe cases may require 8 weeks. 3

• Patients with thyrotoxicosis and dysphagia face higher risk for aspiration pneumonia and thyroid storm, making early recognition critical. 3

Additional Supporting Diagnosis Codes

If clinical features suggest thyroid disease, add:

• E03.9 (hypothyroidism, unspecified) if symptoms include fatigue, weight gain, cold intolerance, or constipation 2

• E05.90 (thyrotoxicosis, unspecified) if symptoms include weight loss, palpitations, sweating, or tremor 5, 3

• R63.4 (abnormal weight loss) – commonly accompanies both thyroid-related dysphagia and structural esophageal pathology 5, 3, 6

Critical Clinical Pitfall

Never assume dysphagia is thyroid-related without imaging or endoscopy first. Abnormalities of the mid or distal esophagus can cause referred dysphagia to the throat, and up to 68% of patients with pharyngeal complaints have esophageal pathology. 4, 7, 8 The American College of Radiology recommends biphasic barium esophagram as the preferred initial test for dysphagia, with 96% sensitivity for structural and functional disorders. 7

Diagnostic Algorithm

1. Order TSH alongside—not instead of—appropriate dysphagia imaging (modified barium swallow for oropharyngeal symptoms, biphasic esophagram for esophageal symptoms). 4, 7

2. If TSH is abnormal and imaging shows esophageal dysmotility without structural lesions, treat the thyroid disorder and reassess dysphagia in 3-8 weeks. 2, 3

3. If TSH is normal, proceed with upper endoscopy with biopsies to exclude mucosal lesions, eosinophilic esophagitis, and malignancy. 7

4. If both imaging and endoscopy are normal but dysphagia persists, obtain high-resolution esophageal manometry to classify primary motility disorders. 7