ED Coding and Reimbursement Alert
Check for the Right Tonsillitis Code
Question: Which diagnosis code should we report for acute tonsillitis? Codify Subscriber Answer: Fortunately, EDs that see patients with acute tonsillitis should find a relatively simple path to selecting the most accurate diagnosis code. Although you only had one code to consider under ICD-9, you've had to expand your horizons since ICD-10 wants to know the type of the patient's tonsillitis. The fourth character in your tonsillitis code will identify the organism and the fifth will indicate whether the patient's condition is acute or recurrent, as follows: o J03.00 – Acute streptococcal tonsillitis, unspecified o J03.80 – Acute tonsillitis due to other specified organism o J03.90 – Acute tonsillitis, unspecified A patient that has acute tonsillitis that is not recurrent is assigned an "unspecified" diagnosis. This does not mean that the diagnosis is truly unspecified in these cases. This "unspecified" diagnosis actually means that the patient's acute tonsillitis is not mentioned as recurrent. Payers should not penalize ED providers for using these "unspecified" diagnoses since there are no other alternatives available.
o J03.01 – Acute recurrent streptococcal tonsillitis
o J03.81 – Acute recurrent tonsillitis due to other specified organisms
o J03.91 – Acute recurrent tonsillitis, unspecified.
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