E04.0 ICD-10-CM Code: Nontoxic diffuse goiter
E04.0 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · free HCC coding tools
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FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Disorders of thyroid gland (E00-E07)
E04.0
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceNontoxic diffuse goiter
An enlarged thyroid gland that is spread throughout the entire gland but is not producing excess thyroid hormone.
Buddy Insight
Nontoxic diffuse goiter represents enlargement of the entire thyroid gland without associated thyrotoxicosis or hypothyroidism (euthyroid state).
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
MappedHCC 44
Code-level coefficient reference
Code Book Path
Inclusion Terms
Official- Diffuse (colloid) nontoxic goiter
- Simple nontoxic goiter
Excludes 2
OfficialNo Excludes 2 notes are included in this display for E04.0. Check the code and parent instructions in the Code Book.
Related Codes
Includes
OfficialNo Includes notes are included in this display for E04.0. Check the code and parent instructions in the Code Book.
Excludes 1
Official- transitory endocrine and metabolic disorders specific to newborn (P70-P74)Inherited from E00-E89, E04
- congenital goiter (NOS) (diffuse) (parenchymatous) (E03.0)Inherited from E00-E89, E04
- iodine-deficiency related goiter (E00-E02)Inherited from E00-E89, E04
Code First
OfficialNo Code First sequencing instructions are included in this display for E04.0. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for E04.0. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for E04.0. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 E04.0 an HCC code?
E04.0 is not in the CMS-HCC V28 or V24 community payment model. E04.0 has a separate mapping under the Part D RxHCC model (HCC 44 (Thyroid Disorders)); the applicable result needs member context.
- Code
- E04.0
- Description
- Nontoxic diffuse goiter
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
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 E04.0 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for E04.0
For E04.0, 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
E04.0 is the ICD-10-CM diagnosis code for nontoxic diffuse goiter. An enlarged thyroid gland that is spread throughout the entire gland but is not producing excess thyroid hormone. E04.0 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).
E04.0 has no mapping under the CMS-HCC V28 or V24 community payment models. E04.0 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.
Confirm the goiter is nontoxic (not causing hyperthyroidism); if toxic features are present, use E05 codes instead.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for E04.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm the goiter is nontoxic (not causing hyperthyroidism); if toxic features are present, use E05 codes instead
- •Document whether the patient has symptoms of compression (difficulty swallowing, breathing) as this affects management
Clinical Significance
Nontoxic diffuse goiter represents enlargement of the entire thyroid gland without associated thyrotoxicosis or hypothyroidism (euthyroid state). Common causes include physiologic goiter during puberty or pregnancy, autoimmune thyroiditis without functional change, and sporadic goiter of unknown etiology. While often benign, large goiters can cause compressive symptoms including dysphagia, dyspnea, and stridor, potentially requiring surgical intervention.
Documentation Requirements
- ✓Documentation should confirm diffuse thyroid enlargement with normal thyroid function (euthyroid status).
- ✓Thyroid function tests demonstrating normal thyroid-stimulating hormone and free thyroxine levels, thyroid ultrasound findings showing diffuse enlargement without suspicious nodules, and assessment for compressive symptoms should be recorded.
- ✓The non-toxic (euthyroid) nature must be established to distinguish from toxic goiter.
Commonly Confused Codes
- •E01.0 (Iodine-deficiency related diffuse goiter) requires an iodine-deficiency etiology.
- •E05.00 (Thyrotoxicosis with diffuse goiter without crisis) captures Graves disease with hyperthyroidism.
- •E06.3 (Autoimmune thyroiditis) may cause diffuse goiter but identifies a specific autoimmune etiology.
- •E04.1 (Nontoxic single thyroid nodule) and E04.2 (Nontoxic multinodular goiter) capture nodular rather than diffuse patterns.