Otolaryngology Coding Alert

Fortunately, however, coding choices for this condition won’t expand dramatically.

Your otolaryngology practice probably sees patients with symptoms of strep throat every day, and this common illness is marked by pain and redness in the throat, potential fever, and sometimes a rash.

ICD-9 Coding Rules: When using the ICD-9-CM code set, you report 034.0 (Streptococcal sore throat) if the patient suffers from streptococcal sore throat. The ICD-9 manual also directs you to this code if the patient suffers from streptococcal tonsillitis.

ICD-10 Changes: Effective Oct. 1, 2014, you won’t have a simple catch-all code for streptococcal throat infections. Instead, ICD-10 will differentiate between streptococcal pharyngitis and streptocollal tonsillitis, as follows:

·         J02.0 (Streptococcal pharyngitis)

·         J03.00 (Acute streptococcal tonsillitis, unspecified)

·         J03.01 (Acute recurrent streptococcal tonsillitis)

Documentation: You should not report the strep throat diagnosis code unless your practice receives confirmation from a lab test (either rapid strep or throat culture) indicating that the patient tested positive for a streptococcal throat infection. If you don’t have a positive lab test confirming strep throat, you should simply report the diagnosis codes for the symptoms (such as sore throat, fever, etc.)

Therefore, your documentation must include a copy of the laboratory report confirming that the patient had strep throat before you select your diagnosis code.

The otolaryngologist will need to clearly note which type of throat condition the patient has. Unlike in the past, when one code covered both streptococcal pharyngitis and streptococcal tonsillitis, that won’t be the case after ICD-10 takes effect. Therefore, it will be important for your documentation to include a notation of whether the patient’s streptococcal infection affected the pharynx or the tonsils.

In addition, if the patient suffers from streptococcal tonsillitis, you will have to further delineate whether he is experiencing an acute or recurrent condition. If you use J03.01 (recurrent), your documentation will have to confirm that the patient has suffered from the condition in the past. This could support a higher level of associated E/M service.

Coder tips: Make sure that you print both new strep throat codes on your superbills prior to ICD-10 implementation, and let your practitioners know that they will need to differentiate between streptococcal pharyngitis vs. streptococcal tonsillitis.