QUESTION: How do you code acute tonsillitis with acute pharyngitis and/or tonsillopharyngitis?

J03.90 Acute Tonsillitis has excludes 1 note for “acute sore throat (J02.-). Pharyngitis codes to J02.9. Instruction note at the beginning of Chapter 10 states “when a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site (i.e. tracheobronchitis to bronchitis in J40).

So do you have to code J02.9 only?

RMC RESPONSE: Acute Tonsillitis and acute pharyngitis and tonsillopharyngitis are all different and need to be coded separately.  There is not a combination code in ICD10 for these (coders are not allowed to combine terms i.e. acute tonsillitis and acute pharyngitis do not equal tonsillopharyngitis)  If documented as “tonsillopharyngitis”, that cannot be indexed and then the instructional note would apply and the lower anatomic site would coded J02.9.
The instructional note is not applicable for tonsillitis and pharyngitis because tonsillitis and pharyngitis are indexable. 

Because these are two separate areas and the provider denotes them individually, RMC trainer team feel it is appropriate to override the excludes 1 note and code them both. 

You can have acute tonsillitis without acute pharyngitis.


RMC’s AHIMA Approved ICD-10 Trainers meet multiple times per week fielding questions from clients and staff.  Below is an actual question that was submitted, along with our team’s response.  Let us know your thoughts! We want YOU to join the conversation! 10xquestions@rmcinc.org

Every effort has been made to answer these questions to the best of RMC’s abilities, at the time the original question was submitted.  Answers should not be considered official coding advice, and we always encourage conversation and dialogue regarding our responses.  As best practice policy, always be sure to refer to your Official Coding Guidelines , Coding Clinic, CPT Assistant, etc.