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ICD-10 Guide
ICD-10 CodesJ01.90

J01.90

Acute sinusitis, unspecified

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

Code Description

ICD-10 J01.90 is a billable code used to indicate a diagnosis of acute sinusitis, unspecified.

Key Diagnostic Point:

Acute sinusitis, unspecified (ICD-10 code J01.90) refers to the inflammation of the paranasal sinuses that occurs suddenly and is characterized by symptoms such as nasal congestion, facial pain or pressure, purulent nasal discharge, and sometimes fever. The paranasal sinuses include the maxillary, frontal, ethmoid, and sphenoid sinuses, which are air-filled spaces located within the bones of the face and skull. Acute sinusitis can be triggered by viral infections, bacterial infections, or allergies, leading to obstruction of the sinus drainage pathways. The disease typically progresses from an upper respiratory infection, with symptoms lasting less than four weeks. Diagnostic considerations include a thorough clinical history, physical examination, and, if necessary, imaging studies like CT scans to assess sinus involvement. The diagnosis is often made based on clinical criteria, and treatment may involve symptomatic relief with decongestants, nasal corticosteroids, and, in some cases, antibiotics if a bacterial infection is suspected.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as it requires differentiation from other respiratory conditions.
  • Treatment complexity: Moderate, as treatment may vary based on the underlying cause.
  • Documentation requirements: Requires detailed documentation of symptoms and clinical findings.
  • Coding specificity: Moderate, as it is unspecified and may require additional codes for associated conditions.

Audit Risk Factors

  • Common coding errors: Misclassification of acute sinusitis as chronic or allergic.
  • Documentation gaps: Insufficient detail in clinical notes about symptoms and duration.
  • Billing challenges: Potential denials due to lack of specificity in diagnosis.

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

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Acute sinusitis is a common condition that affects a significant portion of the population, leading to increased healthcare utilization, including office visits and prescriptions. Understanding the epidemiology of acute sinusitis can help healthcare providers implement effective management strategies and improve patient outcomes. Quality measures related to the treatment of acute sinusitis can enhance care delivery and reduce unnecessary antibiotic use, addressing public health concerns regarding antibiotic resistance.

ICD-9 vs ICD-10

Acute sinusitis is a common condition that affects a significant portion of the population, leading to increased healthcare utilization, including office visits and prescriptions. Understanding the epidemiology of acute sinusitis can help healthcare providers implement effective management strategies and improve patient outcomes. Quality measures related to the treatment of acute sinusitis can enhance care delivery and reduce unnecessary antibiotic use, addressing public health concerns regarding antibiotic resistance.

Reimbursement & Billing Impact

Reimbursement may vary based on the payer's policies, and it is essential to ensure that the documentation aligns with the coding. Common denials can occur if the diagnosis lacks specificity or if the clinical notes do not adequately support the treatment provided. Best practices include using detailed clinical notes and ensuring that all relevant symptoms and treatments are documented to facilitate accurate billing.

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 J01.90?

J01.90 covers acute sinusitis without specifying the sinus involved. It includes cases where the exact sinus affected is unknown or not documented.

When should J01.90 be used instead of related codes?

J01.90 should be used when the clinician has not specified the type of acute sinusitis or when the documentation does not support a more specific code.

What documentation supports J01.90?

Documentation should include a detailed account of the patient's symptoms, duration of illness, any relevant imaging studies, and the clinical rationale for the diagnosis.