Question J35.03 and J35.3

Savannah

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Is anyone getting Denials for these codes as not billable together?
Anthem and Wellcare are denying as Invalid Dx and when we called they said it was the DX code Combination.

Thank you
 

Munzueta

Guru
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El Paso
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They should not be coded together.

Hypertrophy - means enlargement

Hypertrophy of tonsils and adenoids = enlarment of tonsils and adenoids

Tonsillitis and adenoiditis - inflammaiton/infection of tonsils and adenoids

if you use code J35.3 you are saying the patient has enlarged tonsils/adenoids without a known cause such an infection, but if you use code J3503 you are saying they are enlarged because it is an infection, so is inappropriate to code them together.

hope this helps!
 
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