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ICD-10 Guide
ICD-10 CodesJ35.0

J35.0

Chronic tonsillitis and adenoiditis

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

Code Description

ICD-10 J35.0 is a used to indicate a diagnosis of chronic tonsillitis and adenoiditis.

Key Diagnostic Point:

Chronic tonsillitis and adenoiditis are inflammatory conditions affecting the tonsils and adenoids, which are lymphoid tissues located in the oropharynx and nasopharynx, respectively. Clinically, patients may present with recurrent sore throats, difficulty swallowing, snoring, and obstructive sleep apnea due to enlarged tonsils and adenoids. The disease progression can lead to chronic infections, impacting respiratory function and overall health. Diagnosis typically involves a thorough clinical evaluation, including a history of recurrent infections and physical examination findings such as enlarged tonsils or adenoids. Imaging studies, such as X-rays or CT scans, may be utilized to assess the size and impact on surrounding structures. Laboratory tests may be conducted to rule out other infections. Chronic tonsillitis and adenoiditis can significantly affect quality of life, particularly in children, leading to missed school days and impaired social interactions. Treatment often involves conservative management with antibiotics for acute exacerbations, but surgical intervention, such as tonsillectomy or adenoidectomy, may be indicated for persistent cases.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires clinical evaluation and possible imaging
  • Treatment complexity: May involve both medical and surgical management
  • Documentation requirements: Detailed history and physical exam findings needed
  • Coding specificity: Requires accurate differentiation from acute conditions

Audit Risk Factors

  • Common coding errors: Misclassification as acute instead of chronic
  • Documentation gaps: Incomplete history of recurrent infections
  • Billing challenges: Denials due to lack of supporting evidence for chronicity

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

Pediatrics

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Chronic tonsillitis and adenoiditis can significantly impact population health, particularly in pediatric populations, leading to increased healthcare utilization due to recurrent infections and associated complications. Quality measures may include tracking the frequency of surgical interventions and the effectiveness of conservative management strategies. Understanding the epidemiology of these conditions helps in developing targeted interventions to reduce incidence and improve patient outcomes.

ICD-9 vs ICD-10

Chronic tonsillitis and adenoiditis can significantly impact population health, particularly in pediatric populations, leading to increased healthcare utilization due to recurrent infections and associated complications. Quality measures may include tracking the frequency of surgical interventions and the effectiveness of conservative management strategies. Understanding the epidemiology of these conditions helps in developing targeted interventions to reduce incidence and improve patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the payer, and it is crucial to ensure that the medical necessity for procedures like tonsillectomy or adenoidectomy is clearly documented. Common denials may arise from insufficient evidence of chronicity or lack of prior conservative treatment attempts. Best practices include maintaining thorough clinical notes and ensuring that all relevant codes are accurately reported 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 J35.0?

J35.0 covers chronic tonsillitis and adenoiditis, characterized by recurrent inflammation and infection of the tonsils and adenoids, leading to symptoms such as sore throat, difficulty swallowing, and sleep disturbances.

When should J35.0 be used instead of related codes?

J35.0 should be used when both chronic tonsillitis and adenoiditis are present. If only one condition is diagnosed, the specific code for that condition (J35.1 or J35.2) should be used.

What documentation supports J35.0?

Documentation should include a detailed patient history of recurrent throat infections, physical examination findings indicating enlarged tonsils and adenoids, and any imaging studies that support the diagnosis.