What is ICD-10 code E03.0?

E03.0 is the ICD-10-CM diagnosis code for Congenital hypothyroidism with diffuse goiter. A condition present at birth where the thyroid doesn't produce enough hormones and is also enlarged (goiter), resulting from thyroid development problems. It belongs to the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89). E03.0 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. E03.0 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. E03.0 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. E03.0 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does E03.0 map to under V28?

E03.0 has no payable CMS-HCC V28 mapping in the final FY2026 CMS file.

What RAF reference is published for E03.0?

E03.0 has no V28 reference coefficient because the final FY2026 source verifies no payable V28 mapping.

What is the V28 vs V24 difference for E03.0?

E03.0 has verified no payable V28 mapping in the final FY2026 source. Select a historical effective period before making any V24 comparison.

What documentation supports E03.0?

Distinguish from E03.1 by confirming the presence of goiter on physical examination or imaging Document the etiology if known (dysgenesis, dyshormonogenesis, etc.) for complete coding E03.0 is not a CMS-HCC V28 payment code in the verified current source, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

2026 ICD-10-CM E03.0: Congenital hypothyroidism with diffuse

E03.0 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC coding software

ICD-10-CM Code View

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Code lookupE03.0

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Disorders of thyroid gland (E00-E07)

E03.0

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Congenital hypothyroidism with diffuse goiter

A condition present at birth where the thyroid doesn't produce enough hormones and is also enlarged (goiter), resulting from thyroid development problems.

Buddy Insight

Congenital hypothyroidism with diffuse goiter occurs when the thyroid gland is present but unable to produce adequate thyroid hormone, leading to compensatory enlargement.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

Mapped

HCC 44

Thyroid Disorders

Code-level coefficient reference

Code Book Path

Official

E03Other hypothyroidism E03.0Congenital hypothyroidism with diffuse goiter

Inclusion Terms

Official

Congenital parenchymatous goiter (nontoxic)
Congenital goiter (nontoxic) NOS

Excludes 2

Official

No Excludes 2 notes are included in this display for E03.0. Check the code and parent instructions in the Code Book.

Related Codes

Official

E03.1Congenital hypothyroidism without goiter E03.2Hypothyroidism due to medicaments and other exogenous substances E03.3Postinfectious hypothyroidism E03.4Atrophy of thyroid (acquired)E03.5Myxedema coma

Includes

Official

No Includes notes are included in this display for E03.0. Check the code and parent instructions in the Code Book.

Excludes 1

Official

transitory congenital goiter with normal function (P72.0)
transitory endocrine and metabolic disorders specific to newborn (P70-P74)Inherited from E00-E89, E03
iodine-deficiency related hypothyroidism (E00-E02)Inherited from E00-E89, E03
postprocedural hypothyroidism (E89.0)Inherited from E00-E89, E03

Code First

Official

No Code First sequencing instructions are included in this display for E03.0. Check the code and parent instructions in the Code Book.

Use Additional

Official

No Use Additional Code instructions are included in this display for E03.0. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for E03.0. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Documentation should confirm congenital hypothyroidism with a diffuse goiter present since birth or early infancy.

Newborn screening results, confirmatory thyroid function tests (elevated thyroid-stimulating hormone, low free thyroxine), thyroid imaging or ultrasound findings, and the etiology if identified should be recorded.

Current levothyroxine dose, growth trajectory, and developmental milestones should be documented at follow-up visits.

MEAT Support

HCC Buddy guidance

Documentation should confirm congenital hypothyroidism with a diffuse goiter present since birth or early infancy.

Current levothyroxine dose, growth trajectory, and developmental milestones should be documented at follow-up visits.

Audit Caution

HCC Buddy guidance

Ensure the hypothyroidism is truly congenital (present from birth) and not acquired in childhood.

The presence of a goiter distinguishes this from agenesis or ectopic thyroid (E03.1).

Do not confuse with transient neonatal hypothyroidism, which resolves spontaneously.

Ensure ongoing levothyroxine treatment is documented at each visit to support the active diagnosis.

Common Mistakes

HCC Buddy guidance

E03.1 (Congenital hypothyroidism without goiter) is used when the thyroid is absent (agenesis) or ectopic without enlargement.

E00.1 (Congenital iodine-deficiency syndrome, myxedematous type) has a specific iodine-deficiency etiology.

E01.0 (Iodine-deficiency related diffuse goiter) is for acquired, not congenital, iodine-deficiency goiter.

E07.1 (Dyshormonogenetic goiter) may overlap etiologically.

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is E03.0 an HCC code?

E03.0 is not in the CMS-HCC V28 or V24 community payment model. E03.0 has a separate mapping under the Part D RxHCC model (HCC 44 (Thyroid Disorders)); the applicable result needs member context.

Code: E03.0
Description: Congenital hypothyroidism with diffuse goiter
HCC (V28): No CMS-HCC V28 mapping
RAF reference coefficient: —
Billable: Yes
Payment year: 2026

HCC Category Mapping

RxHCCHCC 44, Thyroid Disorders

Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work E03.0 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for E03.0

For E03.0, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Coder workflow notes

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What This Code Means

E03.0 is the ICD-10-CM diagnosis code for congenital hypothyroidism with diffuse goiter. A condition present at birth where the thyroid doesn't produce enough hormones and is also enlarged (goiter), resulting from thyroid development problems. E03.0 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering disorders of thyroid gland (e00-e07).

E03.0 has no mapping under the CMS-HCC V28 or V24 community payment models. E03.0 has a separate mapping under the Part D RxHCC model (HCC 44 (Thyroid Disorders)); the applicable result needs member context. Do not assign V28 risk adjustment value from this page; verify the applicable model and payment year before using this code for risk adjustment.

Distinguish from E03.1 by confirming the presence of goiter on physical examination or imaging.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for E03.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Distinguish from E03.1 by confirming the presence of goiter on physical examination or imaging
•Document the etiology if known (dysgenesis, dyshormonogenesis, etc.) for complete coding

Clinical Significance

Congenital hypothyroidism with diffuse goiter occurs when the thyroid gland is present but unable to produce adequate thyroid hormone, leading to compensatory enlargement. Common causes include dyshormonogenesis (enzyme defects in thyroid hormone synthesis) and transplacental passage of maternal goitrogens or antithyroid antibodies. Early identification through newborn screening and prompt levothyroxine replacement are critical to prevent irreversible intellectual disability and growth impairment.

Documentation Requirements

✓Documentation should confirm congenital hypothyroidism with a diffuse goiter present since birth or early infancy.
✓Newborn screening results, confirmatory thyroid function tests (elevated thyroid-stimulating hormone, low free thyroxine), thyroid imaging or ultrasound findings, and the etiology if identified should be recorded.
✓Current levothyroxine dose, growth trajectory, and developmental milestones should be documented at follow-up visits.

Excludes 1, Do NOT code together

transitory congenital goiter with normal function (P72.0)

Commonly Confused Codes

•E03.1 (Congenital hypothyroidism without goiter) is used when the thyroid is absent (agenesis) or ectopic without enlargement.
•E00.1 (Congenital iodine-deficiency syndrome, myxedematous type) has a specific iodine-deficiency etiology.
•E01.0 (Iodine-deficiency related diffuse goiter) is for acquired, not congenital, iodine-deficiency goiter.
•E07.1 (Dyshormonogenetic goiter) may overlap etiologically.