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Otolaryngology Coding Alert


Add 'Unspecified' to Your Acute Pharyngitis Descriptor

One word is the only difference between old and new.

When you still reported diagnoses based on the ICD-9- CM manual, you had a single code to report for patients diagnosed with acute pharyngitis: 462. Other conditions that applied to this code included:

  • Acute sore throat, not otherwise specified (NOS)
  • Acute pharyngitis (NOS, gangrenous, infective, phlegmonous, pneumococcal, staphylococcal, suppurative, or ulcerative)
  • Sore throat (viral) NOS
  • Viral pharyngitis.

ICD-10 changes: Now that we’ve transitioned to ICD-10, you submit J02.9 to report unspecified type of acute pharyngitis. Codes 462 and J02.9 almost share the same descriptor, with the only difference being the addition of the word “unspecified” to J02.9. Report J02.9 when the patient is first seen. You can submit a more accurate diagnosis for the specific cause when the physician sees the patient for a follow-up and has more data.

Documentation: The ENT may order a throat culture to determine whether the pharyngitis is bacterial, and identify the specific bacteria. She may also order a chest x-ray to rule out pneumonia, and a CT scan of the soft tissue of the neck to rule out an abscess or tumor.

Coder tips: If a patient presents with a sore throat and beefy red pharynx, your physician could order two swabs, one for a rapid strep test and one for a culture. You would report 87081 (Culture, presumptive, pathogenic organisms, screening only) for the culture if you are performing the culture in the office. Report 87880 (Infectious agent antigen detection by immunoassay with direct optical observation; streptococcus, group A) for the rapid strep test, and link J02.9 if the test comes out negative. You need a CLIA waiver to report both these tests, so even if you are not doing cultures in your office and are only doing rapid strep tests, you need to have a CLIA waiver in order to be paid for 87880.

Explanation: A patient suffers from acute pharyngitis if she’s had inflammation of the pharynx lasting for a short period of time (tonsils can also be involved). She may complain of a sore throat of sudden onset and varying duration, difficulty with or discomfort on swallowing, chills, malaise, and fever.

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