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ICD-10 Guide
ICD-10 CodesJ35.02

J35.02

Chronic adenoiditis

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

Code Description

ICD-10 J35.02 is a billable code used to indicate a diagnosis of chronic adenoiditis.

Key Diagnostic Point:

Chronic adenoiditis is characterized by the persistent inflammation of the adenoids, which are lymphoid tissues located at the back of the nasal cavity. This condition often presents with symptoms such as nasal obstruction, chronic nasal discharge, and recurrent ear infections due to Eustachian tube dysfunction. The adenoids play a crucial role in the immune response, particularly in young children, but when they become chronically inflamed, they can lead to significant respiratory issues. Disease progression may involve hypertrophy of the adenoids, leading to obstructive sleep apnea and impaired quality of life. Diagnostic considerations include a thorough clinical history, physical examination, and, when necessary, imaging studies such as X-rays or endoscopy to assess adenoid size and inflammation. Chronic adenoiditis is often associated with other respiratory conditions, including asthma and allergic rhinitis, making it essential for healthcare providers to evaluate the patient's overall respiratory health.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differentiation from acute adenoiditis and other respiratory conditions.
  • Treatment complexity: May involve medical management or surgical intervention (adenoidectomy).
  • Documentation requirements: Detailed clinical history and symptomatology must be documented.
  • Coding specificity: Requires accurate coding to reflect chronicity and associated conditions.

Audit Risk Factors

  • Common coding errors: Misclassification as acute adenoiditis or failure to document chronicity.
  • Documentation gaps: Incomplete clinical history or lack of evidence for recurrent infections.
  • Billing challenges: Denials may occur if the necessity for surgery is not well-supported.

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Chronic adenoiditis can significantly impact a child's quality of life, leading to sleep disturbances, impaired learning, and increased healthcare utilization due to recurrent infections. It is essential to address this condition to prevent complications such as obstructive sleep apnea, which can have long-term effects on cardiovascular health. Understanding the epidemiology of chronic adenoiditis helps healthcare providers identify at-risk populations and implement preventive measures.

ICD-9 vs ICD-10

Chronic adenoiditis can significantly impact a child's quality of life, leading to sleep disturbances, impaired learning, and increased healthcare utilization due to recurrent infections. It is essential to address this condition to prevent complications such as obstructive sleep apnea, which can have long-term effects on cardiovascular health. Understanding the epidemiology of chronic adenoiditis helps healthcare providers identify at-risk populations and implement preventive measures.

Reimbursement & Billing Impact

Reimbursement considerations include the necessity of surgical intervention, such as adenoidectomy, which may be subject to prior authorization. Common denials can occur if the documentation does not clearly support the chronic nature of the condition or if there is insufficient evidence of recurrent infections. Best practices include ensuring that all clinical notes are thorough and that the rationale for any surgical procedures is well-articulated in the patient's medical record.

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 J35.02?

J35.02 specifically covers chronic adenoiditis, which may manifest as persistent nasal obstruction, recurrent otitis media, and sleep-disordered breathing due to adenoid hypertrophy.

When should J35.02 be used instead of related codes?

J35.02 should be used when there is clear documentation of chronic adenoiditis, characterized by ongoing symptoms and recurrent infections, differentiating it from acute conditions or other respiratory disorders.

What documentation supports J35.02?

Documentation should include a detailed clinical history of symptoms, physical examination findings, and any relevant imaging studies that confirm the diagnosis of chronic adenoiditis.