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v1.0.0
ICD-10 Guide
ICD-10 CodesJ06.0

J06.0

Acute laryngopharyngitis

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

Code Description

ICD-10 J06.0 is a billable code used to indicate a diagnosis of acute laryngopharyngitis.

Key Diagnostic Point:

Acute laryngopharyngitis, commonly referred to as a sore throat, is an inflammation of the larynx and pharynx, often resulting from viral infections such as the common cold or influenza, but can also be caused by bacterial infections, allergens, or irritants. Clinically, patients may present with symptoms including sore throat, difficulty swallowing, hoarseness, and cough. The anatomy involved includes the larynx, which houses the vocal cords, and the pharynx, which is the muscular tube that connects the nasal cavity to the esophagus. Disease progression can vary; while many cases resolve spontaneously within a week, complications such as secondary bacterial infections or airway obstruction can occur, particularly in pediatric populations. Diagnostic considerations include a thorough history and physical examination, with additional tests such as throat cultures or rapid antigen tests for streptococcal infection if bacterial etiology is suspected. Accurate diagnosis is crucial for appropriate management and to avoid unnecessary antibiotic use.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as differentiation between viral and bacterial causes may require additional testing.
  • Treatment complexity: Low to moderate, typically managed with symptomatic treatment, but may require antibiotics for bacterial cases.
  • Documentation requirements: Moderate, necessitating clear documentation of symptoms, duration, and any diagnostic tests performed.
  • Coding specificity: Medium, as it requires precise coding to differentiate from other respiratory conditions.

Audit Risk Factors

  • Common coding errors: Misclassification with other respiratory conditions or failure to specify acute versus chronic.
  • Documentation gaps: Incomplete symptom descriptions or lack of diagnostic test results.
  • Billing challenges: Potential denials if documentation does not support the diagnosis or if the condition is not clearly defined.

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 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 laryngopharyngitis is prevalent in both pediatric and adult populations, significantly impacting healthcare utilization due to its commonality as a presenting complaint in primary care settings. Understanding its epidemiology is crucial for public health, as it can lead to secondary infections and increased antibiotic use. Quality measures related to appropriate antibiotic prescribing are essential in managing this condition effectively, aiming to reduce unnecessary treatments and promote better health outcomes.

ICD-9 vs ICD-10

Acute laryngopharyngitis is prevalent in both pediatric and adult populations, significantly impacting healthcare utilization due to its commonality as a presenting complaint in primary care settings. Understanding its epidemiology is crucial for public health, as it can lead to secondary infections and increased antibiotic use. Quality measures related to appropriate antibiotic prescribing are essential in managing this condition effectively, aiming to reduce unnecessary treatments and promote better health outcomes.

Reimbursement & Billing Impact

reimbursement.

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 J06.0?

J06.0 covers acute laryngopharyngitis, which may be caused by viral infections (like rhinovirus or influenza), bacterial infections (such as Group A Streptococcus), or irritants. It is characterized by inflammation of both the larynx and pharynx, leading to symptoms like sore throat, hoarseness, and difficulty swallowing.

When should J06.0 be used instead of related codes?

J06.0 should be used when the clinical presentation specifically includes both laryngeal and pharyngeal involvement. If the condition is limited to the pharynx, J02.9 would be more appropriate. Use J06.0 when symptoms indicate inflammation of both areas, particularly with acute onset.

What documentation supports J06.0?

Documentation should include a detailed history of symptoms (onset, duration, severity), physical examination findings (e.g., redness or swelling of the throat), and any diagnostic tests performed (like throat swabs). Clear documentation of the clinical rationale for diagnosis and treatment is essential.