Coding Tonsillitis
Chapter J of the ICD-10-CM coding manual contains the diagnosis codes for coding tonsillitis. The tonsils are part of the lymphatic and immunologic system. They are the body?s first line of defense and are similar to lymph nodes located in the neck, groin, and armpits.
The tonsils are oval shaped, pink structures in the back of the throat and 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, accounting for approximately 30 percent of tonsillitis in children and 10 percent in adults. Other causes include adenovirus, influenza virus, and Epstein-Barr virus.
ICD-10-CM codes for acute tonsillitis are contained in subcategory J03:
- 00 Acute streptococcal tonsillitis, unspecified
- 01 Acute recurrent streptococcal tonsillitis
- 80 Acute tonsillitis due to other specified organism
- 81 Acute recurrent tonsillitis due to other specified organism
An instructional note for J03.80 and J03.81 directs us to use an additional code from B95-B97 to identify the infectious agent.
- 90 Acute tonsillitis, unspecified
- 91 Acute recurrent tonsillitis, unspecified
ICD-10-CM codes for chronic tonsillitis are listed in category J35:
- 01 Chronic tonsillitis
- 03 Chronic tonsillitis and adenoiditis
To provide specificity to code in ICD-10-CM, good clinical documentation includes the time parameter (acute, chronic, or recurrent and the causal organism (e.g., bacteria, such as streptococcus, staphylococcal, and adenovirus, influenza).
All codes in chapter 10, Diseases of the Respiratory System, have an instructional note to also identify any current, history of and/or exposure to environmental smoking or tobacco dependence.
If the tonsillitis is caused by group A streptococcus, an ent specialist will often prescribe a course of antibiotics with penicillin or amoxicillin as a way to treat the infection. In the instance that penicillin can?t be used, cephalosporins and macrolides can be introduced as a replacement to treat the illness. Similarly, as some patients may be allergic to penicillin, a macrolide may be used as an alternative.