ICD-10 Coding Tip: Tonsillitis

The tonsils are part of the lymphatic and immunologic system. They act as filters by trapping germs that pass through the nose and mouth. They also produce antibodies that help fight infection.
Tonsillitis may be either viral or bacterial. Streptococcus pyogenes, the bacteria that causes strep throat, is a common bacterial cause of tonsillitis, accounting for approximately 30 percent of tonsillitis in children and 10 percent in adults. Other causes of tonsillitis include adenovirus, influenza virus, and Epstein-Barr virus.
Adenoiditis is characterized by mouth breathing, noisy breathing, and snoring at night.
In addition, sleep apnea, choking or gasping when sleeping, difficulty swallowing solid food, and a constant throaty voice may be present in both tonsillitis or adenoiditis.
ICD-10-CM codes for acute tonsillitis are contained in subcategory J03:

J03.00 Acute streptococcal tonsillitis, unspecified
J03.01 Acute recurrent streptococcal tonsillitis
J03.80 Acute tonsillitis due to other specified organism
J03.81 Acute recurrent tonsillitis due to other specified organism
When reporting J03.80 and J03.81, use an additional code from B95-B97 to identify the infectious agent.
J03.90 Acute tonsillitis, unspecified
J03.91 Acute recurrent tonsillitis, unspecified

Complete clinical documentation includes the time parameter (acute, chronic, or recurrent), as well as the causal organism (e.g., bacterial, such as streptococcus, staphylococcal, and adenovirus, influenza).
Example: Rebecca comes in with her mother for recurrent, acute staphylococcal aureus tonsillitis. The patient was referred for evaluation and management options.
In this example, documentation supports recurrent, acute staphylococcal aureus tonsillitis. J03.81 Acute recurrent tonsillitis due to other specified organism is the first listed ICD-10-CM code. Based on the instructional note included with J03.81, B95.61 Methicillin susceptible staphylococcus aureus infection as the cause of diseases classified elsewhere should be used also.

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John Verhovshek

John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

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