E04.8
BillableOther specified nontoxic goiter
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is E04.8 an HCC code?
No. E04.8 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 E04.8
For E04.8to 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 E04.8 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
E04.8 is the ICD-10-CM diagnosis code for other specified nontoxic goiter. An enlarged thyroid gland that is not producing excess hormone, caused by conditions not covered by the more specific nontoxic goiter codes. E04.8 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).
E04.8 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). Coding importance is primarily clinical for surgical planning and airway management in cases of substernal or compressive goiter.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for E04.8 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code for unusual causes of nontoxic goiter such as iodine excess, infiltrative diseases, or other rare conditions
- •Always document the specific etiology in the medical record to justify use of this code
Clinical Significance
Other specified nontoxic goiter captures thyroid enlargement with preserved euthyroid function that does not fit the diffuse, single nodule, or multinodular categories. This includes asymmetric goiter, goiter with substernal extension, and other morphologically distinct patterns of thyroid enlargement. Substernal goiter in particular can cause significant compressive symptoms including tracheal deviation, superior vena cava syndrome, and recurrent laryngeal nerve palsy.
Documentation Requirements
- ✓Documentation should describe the specific type of nontoxic goiter that does not fit the standard categories, with thyroid function tests confirming euthyroid status.
- ✓Imaging findings (ultrasound, CT of neck/chest for substernal extension) and assessment for compressive symptoms should be documented.
- ✓Surgical evaluation and referral should be noted when indicated for symptomatic goiters.
Commonly Confused Codes
- •E04.0 (Nontoxic diffuse goiter), E04.1 (Nontoxic single thyroid nodule), and E04.2 (Nontoxic multinodular goiter) are more specific and should be used when the pattern fits.
- •E04.9 (Nontoxic goiter, unspecified) is less specific and should not be used when a specific morphology is documented.
- •J98.09 (Other diseases of mediastinum) might be considered for substernal extension but does not replace the thyroid code.