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ICD-10 Guide
ICD-10 CodesJ35.8

J35.8

Other chronic diseases of tonsils and adenoids

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

Code Description

ICD-10 J35.8 is a billable code used to indicate a diagnosis of other chronic diseases of tonsils and adenoids.

Key Diagnostic Point:

J35.8 refers to other chronic diseases of the tonsils and adenoids, which can significantly impact the respiratory system. The tonsils and adenoids are lymphoid tissues located in the throat and nasopharynx, respectively, playing a crucial role in the immune response. Chronic conditions affecting these structures may include chronic tonsillitis, adenoid hypertrophy, and other inflammatory diseases. Patients often present with recurrent sore throats, difficulty breathing, sleep apnea, and chronic nasal obstruction. Disease progression can lead to complications such as recurrent otitis media, sinusitis, and impaired quality of life due to sleep disturbances. Diagnostic considerations typically involve a thorough clinical history, physical examination, and may include imaging studies or sleep studies to assess for airway obstruction. Treatment options range from conservative management, including antibiotics and corticosteroids, to surgical interventions such as tonsillectomy or adenoidectomy, particularly in cases of significant airway obstruction or recurrent infections.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough evaluation of symptoms and potential imaging studies.
  • Treatment complexity: May involve both medical management and surgical options.
  • Documentation requirements: Detailed clinical notes and history are essential for accurate coding.
  • Coding specificity: Requires differentiation from other respiratory conditions and related codes.

Audit Risk Factors

  • Common coding errors: Misapplication of related codes or failure to specify the condition.
  • Documentation gaps: Incomplete clinical notes that do not support the diagnosis.
  • Billing challenges: Potential denials if the documentation does not clearly justify the medical necessity of procedures.

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Chronic diseases of the tonsils and adenoids can significantly affect population health, particularly in pediatric populations. These conditions can lead to increased healthcare utilization, including emergency visits and surgical interventions. Quality measures may focus on the management of airway obstruction and the reduction of recurrent infections. Epidemiologically, the prevalence of these conditions highlights the need for effective screening and management strategies to improve patient outcomes.

ICD-9 vs ICD-10

Chronic diseases of the tonsils and adenoids can significantly affect population health, particularly in pediatric populations. These conditions can lead to increased healthcare utilization, including emergency visits and surgical interventions. Quality measures may focus on the management of airway obstruction and the reduction of recurrent infections. Epidemiologically, the prevalence of these conditions highlights the need for effective screening and management strategies to improve patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the payer, so it is essential to verify coverage policies. Common denials may arise from insufficient documentation or failure to demonstrate the need for surgical intervention. Best practices include maintaining detailed clinical notes, ensuring accurate coding, and being aware of payer-specific requirements to minimize billing challenges.

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 J35.8?

J35.8 covers a variety of chronic conditions affecting the tonsils and adenoids, including chronic tonsillitis, adenoid hypertrophy, and other inflammatory diseases that do not fall under more specific codes. Diagnostic criteria typically involve recurrent infections, obstructive symptoms, and associated complications.

When should J35.8 be used instead of related codes?

J35.8 should be used when the patient's condition does not fit the more specific categories of chronic tonsillitis or hypertrophy but still involves chronic disease of the tonsils and adenoids. It is essential to assess the clinical presentation and ensure that the documentation supports the use of this code.

What documentation supports J35.8?

Documentation should include a comprehensive clinical history, physical examination findings, and any relevant imaging studies. Notes should detail the frequency of infections, symptoms of airway obstruction, and any previous treatments or interventions undertaken.