ICD 10 Coding Alert

Question: Which diagnosis code should we report for acute tonsillitis?

Maryland 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:

• J03.0 –  Streptococcal tonsillitis 

            o J03.00 – Acute streptococcal tonsillitis, unspecified
            o J03.01 – Acute recurrent streptococcal tonsillitis

• J03.8 – Acute tonsillitis due to other specified organisms

            o J03.80 – Acute tonsillitis due to other specified organism
            o J03.81 – Acute recurrent tonsillitis due to other specified organisms

• J03.9 – Acute tonsillitis, unspecified (which includes follicular tonsillitis [acute], gangrenous tonsillitis [acute], infective tonsillitis [acute], tonsillitis [acute] NOS, and ulcerative tonsillitis [acute])

            o J03.90 – Acute tonsillitis, unspecified
            o J03.91 – Acute recurrent 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.