Pediatric Coding Alert

Question: The pediatrician performs a thorough history and exam for a patient and documents that they have both nasophar­yngitis and acute pharyngitis. I think that I should code both conditions, but my colleague says I only report the pharyngitis. Doesn’t the presence of multiple conditions require multiple codes?

Maine Subscriber

Answer: In this case, your colleague is correct that you only report the pharyngitis. Here’s why.

Usually, if a patient suffers multiple conditions, you’ll need to report each diagnosis. However, respiratory condition coding follows different rules. When it comes to coding conditions related to the respiratory system, anatomy plays a significant role in which diagnosis code to report. First, you need to take a close look at which body part each condition affects. Then, you need to remember the note at the beginning of ICD-10-CM Chapter 10 telling you that “when a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site.”

This means that if your provider documents both nasopharyngitis and acute pharyngitis, for example, you would use just one code — J02.9 (Acute pharyngitis, unspecified) — on its own. That’s because the pharynx is considered anatomically lower in the respiratory system than the nasopharynx.

Note: The Use additional code instructions, which apply to the entire J00-J99 code section, tell you to report whether the patient is exposed to tobacco smoke. If the patient record includes these kinds of details, you’ll want to report codes such as Z77.22 (Contact with and (suspected) exposure to environmental tobacco smoke (acute) (chronic)), F17.- (Nicotine dependence), or Z72.0 (Tobacco use) for any associated tobacco exposure, dependence, or use.