E04.2
BillableNontoxic multinodular goiter
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E04.2 an HCC code?
No. E04.2 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for E04.2
For E04.2to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- 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
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed E04.2 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E04.2 is the ICD-10-CM diagnosis code for nontoxic multinodular goiter. Multiple lumps or nodules throughout the thyroid gland that are not producing excess thyroid hormone. E04.2 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).
E04.2 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
This code does not map to any HCC under V24 or V28, providing no community risk adjustment impact. It maps to RxHCC 44 (Osteoporosis, Vertebral and Pathological Fractures). Clinical value lies in documenting the multinodular pattern for appropriate surveillance and management planning.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for E04.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm multiple nodules are present; if only one nodule exists, use E04.1 instead
- •Document the number of nodules and any concerning features noted on imaging or biopsy
Clinical Significance
Nontoxic multinodular goiter represents a thyroid gland with multiple nodules and preserved euthyroid function. It is one of the most common thyroid disorders, particularly in older adults and women. The clinical significance includes the risk of malignancy within individual nodules (each dominant nodule should be evaluated independently), potential progression to toxic multinodular goiter with autonomous hormone production, and compressive symptoms from goiter enlargement.
Documentation Requirements
- ✓Documentation should confirm multiple thyroid nodules with normal thyroid function tests.
- ✓Thyroid ultrasound describing the number, size, and characteristics of individual nodules should be recorded.
- ✓Fine-needle aspiration results for suspicious nodules per American Thyroid Association guidelines and the surveillance plan should be documented.
- ✓Assessment for compressive symptoms (dysphagia, dyspnea) should be noted.
Commonly Confused Codes
- •E04.1 (Nontoxic single thyroid nodule) is used for a solitary nodule.
- •E01.1 (Iodine-deficiency related multinodular goiter) requires documented iodine-deficiency etiology.
- •E05.20 (Thyrotoxicosis with toxic multinodular goiter) captures multinodular goiter with hyperthyroidism.
- •E04.0 (Nontoxic diffuse goiter) captures diffuse enlargement without distinct nodules.