Pathology/Lab Coding Alert

Question: How can I tell if a condition is “acute” or “chronic?” Our pathologist examined a tonsillectomy specimen with a diagnosis of tonsillitis. I’m confused about how to choose between the acute and chronic tonsillitis ICD-10-CM codes. Is there a specific time limit that distinguishes the two?

Georgia Subscriber

Answer: Unfortunately, ICD-10-CM guidelines and other authoritative sources don’t provide a specific time limit that distinguishes the terms. In fact, there is a large degree of variation in the time a disease must be present for something to be referred to as chronic, so a definitive timeframe will depend on who you ask. Look at the following statements to see a range of time used to define “chronic.”

• The Centers for Disease Control and Prevention (CDC) describes chronic diseases as “conditions that last one year or more and require ongoing medical attention or limit activities of daily living or both.”
• CPT^® guidelines for evaluation and management (E/M) codes list a stable, chronic illness as “a problem with an expected duration of at least one year or until the death of the patient.”
• The U.S. National Center for Health Statistics defines chronic disease as one lasting three months or more.
• The American Lung Association lists chronic conditions, including chronic cough, which it defines as “a persistent cough that lasts for at least eight weeks, and often much longer.”
• The ICD-10-CM Official Guidelines don’t specifically break down the difference between acute and chronic conditions.

This wide range of definitions makes it clear that you can’t determine acute conditions from chronic ones using time frame alone. Generally, an acute condition involves symptoms that appear suddenly and worsen rapidly, while a chronic condition develops gradually and worsens over a long period of time.

Bottom line: Whether a condition is defined as acute or chronic comes down to your provider’s judgment. If the documentation lists acute or chronic, then that is how you will determine your code assignment.

From the information you provide, here are the code choices for this case:

• J03.90 (Acute tonsillitis, unspecified) – for acute tonsillitis without a known causative organism or without mention of recurrence
• J35.01 (Chronic tonsillitis)

Without more detail in the medical record, you’ll need to query the provider to be able to select the correct code.