Primary Care Coding Alert

Question: We’re seeing a ton of patients with colds who have a sore throat as a prominent symptom. As most colds have a sore throat, it seems like a sore throat is implied with a cold diagnosis. However, the throat is anatom­ically lower than the sinuses. Do I therefore report the sore throat to comply with the ICD-10 instruction under Disease of the respiratory system (J00-J99)?

Illinois Subscriber

Answer: This is a common source of confusion. The instruction you’re referring to reads, “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 (e.g., tracheobronchitis to bronchitis in J40).”

But: Your initial thought is correct. If the physician diagnoses the patient with a cold, you’ll use J00 (Acute nasopharyngitis [common cold]) and not include a code from J02.- (Acute pharyngitis). A sore throat is implied within the cold diagnosis, so ICD-10 has listed it as the first code in the Excludes1 instructions for J00.

Pay close attention to the documentation for evidence that the patient suffers chronic rather than acute pharyngitis. If the physician has clearly documented the sore throat as being chronic, you’ll code that that as J31.2 (Chronic pharyngitis) and submit it in addition to J00. This is because J31.2 is mentioned in the Excludes2 list for J00, meaning you can submit the two codes together.