Primary Care Coding Alert

Wait for lab results before assigning the final code.

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

ICD-10 changes: When ICD-10 becomes effective in October 2014, you won’t have a simple catch-all code for streptococcal throat infections. Instead, ICD-10 will differentiate between streptococcal laryngitis, pharyngitis, and tonsillitis, so your documentation will need to specify type. The four diagnosis choices will be:

·         J02.0 (Streptococcal pharyngitis)

·         J03.00 (Acute streptococcal tonsillitis, unspecified)

·         J03.01 (Acute recurrent streptococcal tonsillitis)

·         J04.0 (Acute laryngitis).

Code J04.0 requires you to use an additional code to report the infectious agent. For strep, that code would be B95.__ (Streptococcus, Staphylococcus, and Enterococcus as the cause of diseases classified elsewhere), with the exact code depending on the nature of the streptococcus.

Documentation tip: Don’t report the strep throat diagnosis code unless your physician 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.).

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

The family physician will need to clearly note which type of throat condition the patient has, so you can code according to whether the patient’s streptococcal infection affected the larynx, pharynx or the tonsils.

In addition, if the patient suffers from streptococcal tonsillitis, you will have to further delineate whether he is experiencing an unspecified or recurrent acute condition. If you use J03.01 (recurrent), your documentation must confirm that the patient has suffered from the condition in the past.

Coder tips: Make sure that you print the 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 laryngitis, pharyngitis, and tonsillitis.