Acute upper respiratory infections
ICD-10 Codes (53)
J01J01.0J01.00J01.01J01.1J01.10J01.11J01.2J01.20J01.21J01.3J01.30J01.31J01.4J01.40J01.41J01.8J01.80J01.81J01.9J01.90J01.91J02J02.0J02.8J02.9J03J03.0J03.00J03.01J03.8J03.80J03.81J03.9J03.90J03.91J04J04.0J04.1J04.10J04.11J04.2J04.3J04.30J04.31J05J05.0J05.1J05.10J05.11J06J06.0J06.9Updates & Changes
FY 2026 Updates
New Codes (1)
Revised Codes (2)
Deleted Codes
No codes deleted in this range for FY 2026
Historical Changes
- •FY 2025: Enhanced viral upper respiratory infection coding
- •FY 2024: Added post-COVID upper respiratory complications
- •FY 2023: Updated pediatric upper respiratory infection guidelines
Upcoming Changes
- •Proposed codes for long-term effects of respiratory viruses
- •Under review: Enhanced telehealth diagnosis coding for URI
Implementation Guidance
- •Review all FY 2026 updates for J00-J06 codes before implementation
- •Always verify the most current codes in the ICD-10-CM manual
- •Ensure clinical documentation supports the selected diagnosis codes
- +3 more guidance items...
Range Overview
The ICD-10 code range J00-J06 covers Acute Upper Respiratory Infections, which include conditions such as common cold (J00), acute sinusitis (J01), acute pharyngitis (J02), acute tonsillitis (J03), acute laryngitis and tracheitis (J04), acute obstructive laryngitis [croup] and epiglottitis (J05), and acute upper respiratory infections of multiple and unspecified sites (J06). These codes are used to document diagnoses related to acute infections of the upper respiratory tract.
Key Usage Points:
- •Always code to the highest level of specificity, meaning use the most detailed code available.
- •Use additional codes, if necessary, to identify any associated tobacco use.
- •For patients with both acute and chronic conditions, code both and sequence the acute condition first.
- •When coding for acute sinusitis, specify the sinus involved.
- •For acute tonsillitis, specify the causative agent if known.
Coding Guidelines
When to Use:
- ✓When a patient presents with symptoms of a common cold.
- ✓When a patient is diagnosed with acute sinusitis.
- ✓When a patient has acute pharyngitis.
- ✓When a patient has acute tonsillitis.
- ✓When a patient has acute laryngitis and tracheitis.
When NOT to Use:
- ✗When the condition is chronic, not acute.
- ✗When the condition is located in the lower respiratory tract.
- ✗When the condition is an allergy, not an infection.
- ✗When the condition is a complication of surgery.
- ✗When the condition is due to a congenital anomaly.
Code Exclusions
Always verify exclusions in the ICD-10-CM manual before assigning a code.
Documentation Requirements
Proper documentation for acute upper respiratory infections should include the specific diagnosis, severity of the condition, causative agent if known, and any associated conditions. The documentation should be clear, concise, and specific.
Clinical Information:
- •Specific diagnosis
- •Severity of the condition
- •Causative agent, if known
- •Associated conditions
Supporting Evidence:
- •Clinical notes
- •Lab results
- •Imaging results
- •Referral notes
Good Documentation Example:
Patient presents with severe acute bacterial sinusitis of the maxillary sinus. Confirmed by CT scan.
Poor Documentation Example:
Patient has sinusitis.
Common Documentation Errors:
- âš Not documenting the severity of the condition
- âš Not specifying the site of the infection
- âš Not including the causative agent, if known
- âš Not coding associated conditions
Range Statistics
Coding Complexity
The complexity of coding acute upper respiratory infections lies in the need to accurately identify the specific site of the infection, the causative agent if known, and any associated conditions. Additionally, distinguishing between acute and chronic conditions is crucial, as is applying the correct sequencing of codes.
Key Factors:
- â–¸Determining the specific site of the infection
- â–¸Identifying the causative agent
- â–¸Distinguishing between acute and chronic conditions
- â–¸Coding associated conditions
- â–¸Applying the correct sequencing of codes
Specialty Focus
These codes are primarily used by primary care physicians, pediatricians, and otolaryngologists (ENT specialists). They are also used by emergency medicine physicians and hospitalists when treating acute conditions.
Primary Specialties:
Clinical Scenarios:
- • A child presenting with croup
- • An adult with a severe sinus infection
- • A teenager with strep throat
- • An elderly patient with a common cold
- • A patient with acute tonsillitis due to mononucleosis
Resources & References
Resources for coding acute upper respiratory infections include the ICD-10-CM manual, coding webinars and seminars, coding newsletters and bulletins, and clinical reference materials.
Official Guidelines:
- ICD-10-CM Official Guidelines for Coding and Reporting
- American Health Information Management Association (AHIMA) guidelines
- American Academy of Professional Coders (AAPC) guidelines
- Centers for Disease Control and Prevention (CDC) guidelines
Clinical References:
- UpToDate
- Medscape
- WebMD
Educational Materials:
- ICD-10-CM Coding Handbook
- ICD-10-CM Coding Workbook
- Online coding courses
Frequently Asked Questions
How do I code for a patient with both acute and chronic sinusitis?
Code both conditions, sequencing the acute condition first. Use J01 for acute sinusitis and J32 for chronic sinusitis.