ICD-10 Coding for Adenoidal Hypertrophy(J35.2, J35.3)
Complete ICD-10-CM coding and documentation guide for Adenoidal Hypertrophy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Adenoidal Hypertrophy
J35.2-J35.3Primary Range
Hypertrophy of adenoids and tonsils
This range includes codes for hypertrophy of adenoids alone and in combination with tonsils.
Chronic diseases of tonsils and adenoids
Includes chronic adenoiditis, which must be differentiated from hypertrophy.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| J35.2 | Hypertrophy of adenoids | Use when adenoids are enlarged without tonsil involvement. |
|
| J35.3 | Hypertrophy of tonsils with hypertrophy of adenoids | Use when both tonsils and adenoids are enlarged and contribute to symptoms. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for adenoidal hypertrophy
Essential facts and insights about Adenoidal Hypertrophy
Primary ICD-10-CM Codes for adenoidal hypertrophy
Decision Criteria
clinical Criteria
- Nasopharyngoscopy confirms adenoid hypertrophy
coding Criteria
- Do not use if adenoiditis is present
Applicable To
- Adenoid hypertrophy
Excludes
- Chronic adenoiditis (J35.0-)
Clinical Validation Requirements
- Nasopharyngoscopy showing ≥50% choanal obstruction
- Lateral neck X-ray with airway-to-soft-palate ratio <0.5
Code-Specific Risks
- Incorrectly coding without objective obstruction data
Coding Notes
- Ensure documentation includes objective findings of obstruction.
J35.3 - Hypertrophy of tonsils with hypertrophy of adenoids
Use when both tonsils and adenoids are enlarged and contribute to symptoms.
Applicable To
- Tonsillar and adenoidal hypertrophy
Excludes
- Chronic tonsillitis and adenoiditis (J35.0-)
Clinical Validation Requirements
- Imaging showing ≥50% airway obstruction by both tonsils and adenoids
Coding Notes
Ensure both tonsillar and adenoidal hypertrophy are documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Obstructive sleep apnea (adult) (pediatric)
G47.33Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Chronic adenoiditis
J35.0-Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Adenoidal Hypertrophy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code J35.2.
Impact
Clinical: May lead to inappropriate treatment, Regulatory: Non-compliance with documentation standards, Financial: Denial of reimbursement claims
Mitigation Strategy
Always confirm with endoscopy or imaging, Train staff on documentation standards
Impact
Reimbursement: Potential denial of claims due to insufficient documentation, Compliance: Risk of non-compliance with coding standards, Data Quality: Inaccurate clinical data affecting patient care
Mitigation Strategy
Ensure nasopharyngoscopy or imaging confirms obstruction
Impact
Claims may be audited if obstruction is not clearly documented.
Mitigation Strategy
Ensure all documentation includes objective findings.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Adenoidal Hypertrophy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Adenoidal Hypertrophy
Use these documentation templates to ensure complete and accurate documentation for Adenoidal Hypertrophy. These templates include all required elements for proper coding and billing.
Child with obstructive sleep apnea due to adenoidal hypertrophy
Specialty: OtolaryngologyRequired Elements
- Nasopharyngoscopy findings
- Symptoms of nasal obstruction
- Impact on sleep
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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