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ICD-10 Guide
ICD-10 CodesJ03.01

J03.01

Acute recurrent streptococcal tonsillitis

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

Code Description

ICD-10 J03.01 is a billable code used to indicate a diagnosis of acute recurrent streptococcal tonsillitis.

Key Diagnostic Point:

Acute recurrent streptococcal tonsillitis is characterized by the inflammation of the tonsils due to infection by Group A Streptococcus bacteria. Clinically, patients present with symptoms such as sore throat, difficulty swallowing, fever, and swollen lymph nodes. The tonsils, located at the back of the throat, play a role in the immune response, but when infected, they can become enlarged and painful, leading to significant discomfort. Disease progression can vary; some patients may experience recurrent episodes, leading to chronic tonsillitis or complications such as peritonsillar abscess. Diagnosis typically involves a thorough clinical examination, rapid antigen detection tests, or throat cultures to confirm the presence of streptococcal bacteria. Treatment often includes antibiotics to eradicate the infection, and in cases of recurrent episodes, surgical intervention such as tonsillectomy may be considered. Accurate coding is essential for appropriate management and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires confirmation of streptococcal infection through testing.
  • Treatment complexity: Involves both medical management and potential surgical options.
  • Documentation requirements: Must include clinical findings, test results, and treatment plans.
  • Coding specificity: Requires precise coding to differentiate from other types of tonsillitis.

Audit Risk Factors

  • Common coding errors: Misidentifying the type of tonsillitis or failing to document recurrent episodes.
  • Documentation gaps: Incomplete clinical notes or lack of test results can lead to coding inaccuracies.
  • Billing challenges: Denials may occur if documentation does not support the diagnosis or treatment provided.

Specialty Focus

Medical Specialties

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

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

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Documentation Requirements

CPT Code

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Documentation Requirements

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 streptococcal tonsillitis significantly impacts population health, particularly in children and adolescents, leading to increased healthcare utilization. Effective management can reduce complications and improve quality of life. Tracking these cases contributes to understanding epidemiological trends and the effectiveness of public health interventions aimed at reducing the incidence of streptococcal infections.

ICD-9 vs ICD-10

Acute recurrent streptococcal tonsillitis significantly impacts population health, particularly in children and adolescents, leading to increased healthcare utilization. Effective management can reduce complications and improve quality of life. Tracking these cases contributes to understanding epidemiological trends and the effectiveness of public health interventions aimed at reducing the incidence of streptococcal infections.

Reimbursement & Billing Impact

reimbursement and to ensure that all services rendered are appropriately linked to the diagnosis code to avoid billing issues.

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 J03.01?

J03.01 specifically covers acute recurrent episodes of tonsillitis caused by Group A Streptococcus. It is important to differentiate this from other types of tonsillitis, such as viral or chronic forms.

When should J03.01 be used instead of related codes?

J03.01 should be used when the tonsillitis is confirmed to be recurrent and caused by streptococcal infection. If the tonsillitis is acute but not recurrent, or caused by a different pathogen, other codes should be considered.

What documentation supports J03.01?

Documentation should include clinical symptoms, results from throat swabs or rapid tests confirming streptococcal infection, and any treatment plans or follow-up notes indicating recurrent episodes.