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ICD-10 Guide
ICD-10 CodesJ35.2

J35.2

Hypertrophy of adenoids

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

Code Description

ICD-10 J35.2 is a billable code used to indicate a diagnosis of hypertrophy of adenoids.

Key Diagnostic Point:

Hypertrophy of adenoids refers to the abnormal enlargement of the adenoid tissue, which is located in the nasopharynx, behind the nose and above the soft palate. This condition is commonly seen in children and can lead to various respiratory issues, including obstructive sleep apnea, chronic nasal obstruction, and recurrent otitis media due to Eustachian tube dysfunction. Clinically, patients may present with symptoms such as nasal congestion, mouth breathing, snoring, and difficulty sleeping. The disease progression can lead to complications like facial deformities and impaired speech development if left untreated. Diagnosis typically involves a thorough clinical evaluation, including a physical examination and, in some cases, imaging studies such as X-rays or endoscopy to assess the size of the adenoids and their impact on surrounding structures. Treatment options may include medical management with nasal corticosteroids or surgical intervention, such as adenoidectomy, especially in cases where significant airway obstruction or recurrent infections are present.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors
  • Documentation gaps
  • Billing challenges

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

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Hypertrophy of adenoids can significantly impact a child's quality of life, leading to sleep disturbances, behavioral issues, and impaired learning due to chronic fatigue. The condition is prevalent in pediatric populations, with a notable percentage of children experiencing related respiratory issues. Addressing adenoid hypertrophy can improve overall health outcomes, reduce healthcare utilization for recurrent infections, and enhance the quality of life for affected children.

ICD-9 vs ICD-10

Hypertrophy of adenoids can significantly impact a child's quality of life, leading to sleep disturbances, behavioral issues, and impaired learning due to chronic fatigue. The condition is prevalent in pediatric populations, with a notable percentage of children experiencing related respiratory issues. Addressing adenoid hypertrophy can improve overall health outcomes, reduce healthcare utilization for recurrent infections, and enhance the quality of life for affected children.

Reimbursement & Billing Impact

impact on the patient's respiratory function. Reimbursement considerations may vary based on the payer, but typically, surgical interventions like adenoidectomy are well-covered when medically necessary. Common denials may arise from insufficient documentation or failure to demonstrate the necessity of the procedure. Best practices include thorough documentation of symptoms, treatment history, and any prior conservative measures taken before surgical intervention.

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 J35.2?

J35.2 specifically covers hypertrophy of adenoids, which may lead to obstructive sleep apnea, chronic nasal obstruction, and recurrent ear infections. It is important to differentiate this condition from other respiratory disorders that may present with similar symptoms.

When should J35.2 be used instead of related codes?

J35.2 should be used when the primary issue is the hypertrophy of adenoids causing respiratory symptoms or complications. If the tonsils are also hypertrophied, J35.1 may be more appropriate, or a combination of codes may be necessary.

What documentation supports J35.2?

Documentation should include clinical findings such as physical examination results, symptoms reported by the patient or caregivers, and any imaging studies that confirm adenoid hypertrophy. Treatment plans and outcomes should also be documented.