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v1.0.0
ICD-10 Guide
ICD-10 CodesJ02

J02

Acute pharyngitis

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

Code Description

ICD-10 J02 is a used to indicate a diagnosis of acute pharyngitis.

Key Diagnostic Point:

Acute pharyngitis is an inflammation of the pharynx, commonly presenting with sore throat, difficulty swallowing, and sometimes fever. The condition is often viral in origin, with common pathogens including rhinovirus, adenovirus, and influenza virus, but can also be caused by bacterial infections, notably Group A Streptococcus. The pharynx, located behind the nasal cavity and mouth, plays a crucial role in the respiratory system as it serves as a passageway for air and food. Disease progression typically involves the onset of symptoms within a few days of exposure to the pathogen, with acute pharyngitis generally resolving within a week. Diagnostic considerations include a thorough history and physical examination, throat culture, or rapid antigen detection tests to differentiate between viral and bacterial causes. Accurate diagnosis is essential to avoid unnecessary antibiotic use and to manage symptoms effectively.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Differentiating between viral and bacterial causes can be challenging.
  • Treatment complexity: Management may vary based on etiology, requiring careful consideration of antibiotic use.
  • Documentation requirements: Detailed documentation of symptoms, diagnostic tests, and treatment plans is necessary.
  • Coding specificity: Accurate coding requires knowledge of the specific type of pharyngitis and associated symptoms.

Audit Risk Factors

  • Common coding errors: Misclassification of viral vs. bacterial pharyngitis.
  • Documentation gaps: Incomplete records regarding symptomatology and diagnostic tests.
  • Billing challenges: Potential denials due to lack of supporting documentation for antibiotic prescriptions.

Specialty Focus

Medical Specialties

Primary medical specialty: Family Medicine

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: 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

Related Codes

Child Codes

3 codes
J02.0
Streptococcal pharyngitis
J02.8
Acute pharyngitis due to other specified organisms
J02.9
Acute pharyngitis, unspecified

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

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 pharyngitis is a common condition that significantly impacts population health, leading to increased healthcare utilization, including outpatient visits and antibiotic prescriptions. Understanding the epidemiology of acute pharyngitis helps in developing quality measures aimed at reducing unnecessary antibiotic use and improving patient outcomes. Effective management of this condition can lead to better health outcomes and reduced healthcare costs.

ICD-9 vs ICD-10

Acute pharyngitis is a common condition that significantly impacts population health, leading to increased healthcare utilization, including outpatient visits and antibiotic prescriptions. Understanding the epidemiology of acute pharyngitis helps in developing quality measures aimed at reducing unnecessary antibiotic use and improving patient outcomes. Effective management of this condition can lead to better health outcomes and reduced healthcare costs.

Reimbursement & Billing Impact

Reimbursement considerations include the necessity of distinguishing between viral and bacterial infections, as this impacts treatment decisions. Common denials may arise from insufficient documentation supporting the diagnosis or treatment provided. Best practices include ensuring that all clinical encounters are well-documented, with clear notes on the rationale for any prescribed medications, especially antibiotics, to avoid audits and denials.

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 J02?

J02 covers acute pharyngitis, which may be viral or bacterial in origin. It includes conditions such as pharyngitis due to streptococcal infection, viral pharyngitis, and other specified acute pharyngeal infections.

When should J02 be used instead of related codes?

J02 should be used when the primary diagnosis is acute pharyngitis without complications. If the condition is specifically due to tonsillitis or other related conditions, then codes like J03 or J04 may be more appropriate.

What documentation supports J02?

Documentation should include patient history, physical examination findings, results of any throat cultures or rapid tests, and treatment plans. Clear notes on symptom duration and severity are also critical.