Pediatric Coding Alert

Question: How will the laryngitis and strep throat codes change now that ICD-10 is taking over?

Answer: Under ICD-10, you’ll use code J04.0 (Acute laryngitis) to report acute laryngitis without obstruction. In addition, ICD-10 asks you to report an additional code (B95-B97) to identify the infectious agent responsible for the acute laryngitis.

Coder tip: If the patient follows a treatment plan, he or she should have a quick recovery from acute laryngitis. If the patient’s symptoms have not resolved after approximately three weeks, however, the physician should evaluate the patient for chronic laryngitis. The code for this condition will change from 476.0 under ICD-9 to J37.0 (Chronic laryngitis) under ICD-10.

As for strep throat, clear the ICD-9 code 034.0 (Streptococcal sore throat) from your mind. Instead, you’ll report one of the following codes:

• 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 pediatrician 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 (Acute recurrent streptococcal tonsillitis), 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.