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ICD-10 Guide
ICD-10 CodesA54.5

A54.5

Gonococcal pharyngitis

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 A54.5 is a billable code used to indicate a diagnosis of gonococcal pharyngitis.

Key Diagnostic Point:

Gonococcal pharyngitis is an infection of the throat caused by the bacterium Neisseria gonorrhoeae, which is primarily transmitted through sexual contact. This condition is classified as a sexually transmitted infection (STI) and can occur in individuals who engage in oral sex with an infected partner. Symptoms may include sore throat, difficulty swallowing, and swollen lymph nodes, although many individuals may be asymptomatic. Diagnosis is typically confirmed through laboratory testing, including nucleic acid amplification tests (NAATs) or culture. Treatment usually involves the administration of antibiotics, with dual therapy often recommended to combat potential antibiotic resistance. It is crucial for healthcare providers to conduct thorough sexual histories and consider screening for other STIs, as co-infections are common. Contact tracing is essential to prevent further transmission, and partners should be notified and treated accordingly. Public health guidelines emphasize the importance of education on safe sexual practices to reduce the incidence of gonococcal infections.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Need for accurate documentation of sexual history and symptoms.
  • Potential for co-infections with other STIs.
  • Variability in presentation (asymptomatic vs symptomatic).
  • Requirement for laboratory confirmation of diagnosis.

Audit Risk Factors

  • Inadequate documentation of symptoms and sexual history.
  • Failure to document laboratory test results.
  • Lack of follow-up care or partner treatment documentation.
  • Misclassification of the infection site (e.g., throat vs. genital).

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed documentation of patient history, symptoms, and laboratory results.

Common Clinical Scenarios

Patients presenting with sore throat and sexual history indicating potential exposure.

Billing Considerations

Consideration of antibiotic resistance patterns and treatment guidelines.

Primary Care

Documentation Requirements

Comprehensive sexual history and documentation of any associated symptoms.

Common Clinical Scenarios

Routine STI screening in sexually active individuals.

Billing Considerations

Importance of patient education on safe sexual practices.

Coding Guidelines

Inclusion Criteria

Use A54.5 When
  • According to the official coding guidelines, A54
  • 5 should be used when the diagnosis of gonococcal pharyngitis is confirmed through appropriate laboratory testing
  • It is important to document the site of infection and any associated symptoms

Exclusion Criteria

Do NOT use A54.5 When
  • Exclusion criteria include infections caused by other organisms

Related CPT Codes

87591CPT Code

Nucleic acid amplification test for gonorrhea

Clinical Scenario

Used when testing for gonococcal infection in symptomatic patients.

Documentation Requirements

Document the reason for testing and patient symptoms.

Specialty Considerations

Infectious disease specialists may require additional details on treatment response.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of gonococcal infections, improving data accuracy and enhancing public health tracking of STIs.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of gonococcal infections, improving data accuracy and enhancing public health tracking of STIs.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of gonococcal infections, improving data accuracy and enhancing public health tracking of STIs.

Resources

Clinical References

  • •
    CDC Gonorrhea Treatment Guidelines

Coding & Billing References

  • •
    CDC Gonorrhea Treatment Guidelines

Frequently Asked Questions

What are the common symptoms of gonococcal pharyngitis?

Common symptoms include sore throat, difficulty swallowing, and swollen lymph nodes. However, many individuals may be asymptomatic.

How is gonococcal pharyngitis diagnosed?

Diagnosis is typically made through laboratory testing, including nucleic acid amplification tests (NAATs) or culture of the throat.

What is the recommended treatment for gonococcal pharyngitis?

The recommended treatment usually involves dual antibiotic therapy to effectively treat the infection and prevent resistance.