Primary Care Coding Alert

Question: If a patient has a sore throat and a cold, do I code both conditions?

Massachusetts Subscriber

Answer: No. In situations like this, you report only one of the conditions.

Expert coding tip: A common cold is reported with J00 (Acute nasopharyngitis [common cold]). You’ll notice several Excludes1 instructions for the various conditions typically accompanying a cold:

• J02.- (Acute pharyngitis)
• J02.9 (Acute pharyngitis, unspecified)
• J09.X2 (Influenza due to identified novel influenza A virus with other respiratory manifestations)
• J10.1 (Influenza due to other identified influenza virus with other respiratory manifestations)
• J11.1 (Influenza due to unidentified influenza virus with other respiratory manifestations)
• J31.0 (Chronic rhinitis)

A sore throat not otherwise specified is reported with J02.9, which is mutually exclusive (Excludes1). Thus, you can report only one of the two conditions. Since the sore throat typically accompanies the cold, reporting the cold (J00) captures both conditions.

Note: There may be some respiratory illness encounters that call for the use of a second code. If the notes indicate the patient is a smoker or is exposed to tobacco smoke, follow the Use additional code instruction telling you 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).