Otolaryngology Coding Alert

ICD-10 will help you assign more accurate diagnoses.

Acute tonsillitis might be one of the most common diagnoses your otolaryngologist assigns, and one of the easiest for you to code. ICD-9 has only one choice for the condition: 463 (Acute tonsillitis). The code includes several types of tonsillitis, including follicular, gangrenous, septic, viral, suppurative, and ulcerative.

ICD-10 changes: When you begin coding with ICD-10 in October, you’ll have several new options. The new system will add fourth and fifth digits to the code, which leads to a more specific diagnosis. The fourth character will identify the organism and the fifth will indicate whether the patient’s condition is acute or recurrent.

The complete range of diagnoses for acute tonsillitis will expand to:

• 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 organisms
                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.

Documentation: Your physician may use four diagnostic criteria when assessing a patient for acute tonsillitis:

• History of fever
• Tonsillar exudates
• No cough
• Tender anterior cervical lymphadenopathy.

Patients with two of these criteria might merit testing. Your physician should already be documenting the details that will lead you to the most accurate ICD-10 code, but verify that this is the case before using the new system. Otherwise, you’ll be forced to report “unspecified” on more occasions than should be necessary.

Coder tips: One advantage to having more codes with ICD-10 is that you’ll have choices for some situations you can’t code as accurately today. For example, say your ENT sees a patient with acute tonsillitis. The patient had a bout with the same acute condition six months ago, making this the second occurrence in six months. You have no code to report code recurrent tonsillitis with the current ICD-9-CM, so you would usually submit 463. With ICD-10, however, you’ll have a better option. You’ll report the situation with code J03.91 (Acute recurrent tonsillitis, unspecified).

A patient who suffers from acute tonsillitis has an inflammation due to infection of the tonsils. It is a very common condition, most frequent in children aged 5 to 10 years and young adults between 15 and 25 years.