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ICD-10 Guide
ICD-10 CodesJ05.1

J05.1

Acute epiglottitis

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

Code Description

ICD-10 J05.1 is a used to indicate a diagnosis of acute epiglottitis.

Key Diagnostic Point:

Acute epiglottitis is a life-threatening condition characterized by inflammation and swelling of the epiglottis, which can obstruct the airway. This condition is most commonly seen in children but can also occur in adults. Clinically, patients may present with a sudden onset of fever, sore throat, difficulty swallowing (dysphagia), drooling, and stridor, which is a high-pitched wheezing sound indicative of airway obstruction. The anatomy involved includes the epiglottis, a flap of cartilage located at the base of the tongue that prevents food from entering the trachea during swallowing. Disease progression can be rapid, leading to complete airway obstruction within hours. Diagnostic considerations include a thorough clinical examination, imaging studies such as lateral neck X-rays, and direct visualization via laryngoscopy. Prompt recognition and management are crucial to prevent respiratory failure, often necessitating intubation or tracheostomy in severe cases. Treatment typically involves intravenous antibiotics and corticosteroids to reduce inflammation.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity: Requires immediate clinical assessment and potential imaging.
  • Treatment complexity: May involve emergency airway management and hospitalization.
  • Documentation requirements: Detailed clinical notes and evidence of airway assessment are essential.
  • Coding specificity: Requires precise coding to differentiate from other respiratory conditions.

Audit Risk Factors

  • Common coding errors: Misclassification with other upper respiratory infections.
  • Documentation gaps: Incomplete records regarding airway assessment and treatment.
  • Billing challenges: High costs associated with emergency interventions may lead to scrutiny.

Specialty Focus

Medical Specialties

Emergency 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

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Acute epiglottitis has significant clinical implications, particularly in pediatric populations where it can lead to rapid respiratory failure. Its incidence has decreased with widespread vaccination against Haemophilus influenzae type b (Hib), yet it remains a critical concern in unvaccinated individuals. Quality measures focus on timely diagnosis and intervention to improve patient outcomes. Understanding the epidemiology of this condition aids in resource allocation and preventive strategies in healthcare settings.

ICD-9 vs ICD-10

Acute epiglottitis has significant clinical implications, particularly in pediatric populations where it can lead to rapid respiratory failure. Its incidence has decreased with widespread vaccination against Haemophilus influenzae type b (Hib), yet it remains a critical concern in unvaccinated individuals. Quality measures focus on timely diagnosis and intervention to improve patient outcomes. Understanding the epidemiology of this condition aids in resource allocation and preventive strategies in healthcare settings.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the condition, the necessity for emergency airway management, and the length of hospital stay. Common denials may arise from insufficient documentation of the urgency of the condition or failure to provide adequate evidence of treatment protocols. Best practices include thorough clinical notes, clear justification for procedures performed, and adherence to coding guidelines to ensure 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 J05.1?

J05.1 specifically covers acute epiglottitis, which is characterized by inflammation of the epiglottis leading to potential airway obstruction. It is important to differentiate this from other forms of laryngitis or upper respiratory infections.

When should J05.1 be used instead of related codes?

J05.1 should be used when there is a confirmed diagnosis of acute epiglottitis with signs of airway obstruction. It is crucial to differentiate it from other respiratory conditions that do not involve the epiglottis.

What documentation supports J05.1?

Documentation should include clinical findings such as symptoms of respiratory distress, results from imaging studies, and notes on airway management interventions. Evidence of treatment protocols followed is also necessary.