ICD-10 Guide

J01.0

Acute maxillary sinusitis

BILLABLE STATUSNo

IMPLEMENTATION DATEOctober 1, 2015

LAST UPDATED09/06/2025

Code Description

ICD-10 J01.0 is a used to indicate a diagnosis of acute maxillary sinusitis.

Key Diagnostic Point:

Acute maxillary sinusitis is an inflammation of the maxillary sinuses, often resulting from viral infections, bacterial infections, or allergic reactions. Clinically, patients may present with symptoms such as facial pain or pressure, nasal congestion, purulent nasal discharge, fever, and reduced sense of smell. The maxillary sinuses are located in the cheek area, and their inflammation can lead to significant discomfort and complications if untreated. The disease typically progresses from a viral upper respiratory infection, which may resolve on its own, to a bacterial infection requiring medical intervention. Diagnostic considerations include a thorough clinical history, physical examination, and, if necessary, imaging studies such as a CT scan to assess sinus involvement. Differentiating acute maxillary sinusitis from other respiratory conditions, such as allergic rhinitis or chronic sinusitis, is crucial for appropriate management and treatment.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

Diagnostic complexity: Requires clinical evaluation and possibly imaging.
Treatment complexity: May involve antibiotics, nasal corticosteroids, or surgery in severe cases.
Documentation requirements: Detailed clinical history and symptom description are essential.
Coding specificity: Requires accurate coding based on the type and duration of sinusitis.

Audit Risk Factors

Common coding errors: Misclassification of acute vs. chronic sinusitis.
Documentation gaps: Incomplete symptom descriptions or lack of imaging results.
Billing challenges: Denials may occur if documentation does not support the diagnosis.

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 maxillary sinusitis significantly affects population health, leading to increased healthcare utilization due to its prevalence in both adults and children. Quality measures often focus on appropriate antibiotic use and the management of symptoms to prevent complications. Epidemiologically, it is a common condition that can lead to chronic sinusitis if not adequately treated, highlighting the importance of effective diagnosis and management strategies.

ICD-9 vs ICD-10

Reimbursement & Billing Impact

Reimbursement considerations include the patient's insurance policy, which may dictate coverage for diagnostic imaging or surgical procedures. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Best practices include ensuring that all clinical notes are detailed and that any imaging studies are clearly linked to the diagnosis. Coders should also be aware of payer-specific guidelines to avoid billing errors.

Resources

Clinical References

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

Coding & Billing References

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

Frequently Asked Questions

What specific conditions are covered by J01.0?

J01.0 specifically covers acute maxillary sinusitis, which can be caused by viral infections, bacterial infections, or allergies. It is characterized by inflammation of the maxillary sinuses and presents with symptoms such as facial pain, nasal discharge, and fever.

When should J01.0 be used instead of related codes?

J01.0 should be used when the diagnosis is specifically acute maxillary sinusitis. If the condition involves other sinuses or is chronic, other codes such as J01.1 or J32.0 should be considered.

What documentation supports J01.0?

Documentation should include a detailed clinical history, symptomatology, physical examination findings, and any imaging studies performed. Evidence of acute infection and symptom duration is critical for accurate coding.

ICD-10 J01.0 is a used to indicate a diagnosis of acute maxillary sinusitis.