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ICD-10 Guide
ICD-10 CodesJ01.01

J01.01

Acute recurrent maxillary sinusitis

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 J01.01 is a billable code used to indicate a diagnosis of acute recurrent maxillary sinusitis.

Key Diagnostic Point:

Acute recurrent maxillary sinusitis is characterized by the inflammation of the maxillary sinuses, which are located in the cheekbones. Clinically, patients typically present with symptoms such as facial pain or pressure, nasal congestion, purulent nasal discharge, and reduced sense of smell. The condition is often triggered by viral infections, allergies, or bacterial infections, leading to obstruction of the sinus drainage pathways. The disease can progress from an acute episode to recurrent episodes, defined as having multiple acute sinusitis episodes within a year. Diagnostic considerations include a thorough clinical history, physical examination, and, if necessary, imaging studies such as CT scans to assess sinus involvement. Laboratory tests may also be conducted to identify the causative organism in cases of suspected bacterial infection. Effective management often involves symptomatic treatment, nasal corticosteroids, and, in some cases, antibiotics, particularly if bacterial infection is confirmed. Understanding the anatomy of the paranasal sinuses and their drainage pathways is crucial for effective diagnosis and treatment.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from other respiratory conditions such as allergic rhinitis or chronic sinusitis.
  • Treatment complexity: May involve multiple treatment modalities including medications and potential surgical interventions.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis and treatment plan.
  • Coding specificity: Requires accurate coding to differentiate between acute and recurrent episodes.

Audit Risk Factors

  • Common coding errors: Misclassification of acute versus chronic sinusitis.
  • Documentation gaps: Incomplete patient history or lack of imaging results.
  • Billing challenges: Potential denials due to insufficient documentation supporting recurrent episodes.

Specialty Focus

Medical Specialties

Primary medical specialty: Otolaryngology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Secondary specialty: Primary Care

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Acute recurrent maxillary sinusitis significantly impacts patient quality of life, leading to increased healthcare utilization, including frequent visits to primary care and specialist providers. It is a common condition that affects a substantial portion of the population, contributing to lost productivity and increased healthcare costs. Understanding the epidemiology of this condition can help in developing targeted interventions and quality measures aimed at reducing recurrence and improving patient outcomes.

ICD-9 vs ICD-10

Acute recurrent maxillary sinusitis significantly impacts patient quality of life, leading to increased healthcare utilization, including frequent visits to primary care and specialist providers. It is a common condition that affects a substantial portion of the population, contributing to lost productivity and increased healthcare costs. Understanding the epidemiology of this condition can help in developing targeted interventions and quality measures aimed at reducing recurrence and improving patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the payer, and it is essential to verify coverage for diagnostic imaging and procedures related to sinusitis. Common billing challenges include denials due to insufficient documentation or incorrect coding, emphasizing the need for accurate coding practices and thorough clinical notes.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for J00-J99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for J00-J99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by J01.01?

J01.01 covers acute recurrent maxillary sinusitis, which is defined by multiple episodes of acute maxillary sinusitis occurring within a year. Diagnostic criteria include the presence of symptoms such as facial pain, nasal discharge, and imaging findings consistent with maxillary sinus involvement.

When should J01.01 be used instead of related codes?

J01.01 should be used when a patient has a documented history of recurrent episodes of acute maxillary sinusitis, as opposed to a single acute episode or chronic sinusitis, which would require different coding.

What documentation supports J01.01?

Documentation should include a detailed patient history of recurrent symptoms, physical examination findings, imaging results (if applicable), and treatment plans that reflect the recurrent nature of the condition.