ICD-10 Coding for Strep Throat(J02.0, B95.0)
Complete ICD-10-CM coding and documentation guide for Strep Throat. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Strep Throat
J00-J06Primary Range
Acute upper respiratory infections
This range includes codes for acute infections of the upper respiratory tract, including streptococcal pharyngitis.
Bacterial and viral infectious agents
This range includes codes for identifying infectious agents, such as Group A Streptococcus, which are used as additional codes.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| J02.0 | Streptococcal pharyngitis | Use when streptococcal pharyngitis is confirmed by laboratory tests. |
|
| B95.0 | Streptococcus, group A, as the cause of diseases classified elsewhere | Use as an additional code to specify the causative organism in streptococcal infections. |
|
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 strep throat
Essential facts and insights about Strep Throat
Primary ICD-10-CM Codes for strep throat
Decision Criteria
clinical Criteria
- Presence of sore throat, fever, and positive RADT or culture for Group A Streptococcus.
Applicable To
- Strep throat
Excludes
- Acute tonsillitis (J03.-)
Clinical Validation Requirements
- Positive rapid antigen detection test (RADT) for Group A Streptococcus
- Throat culture confirming Group A Streptococcus
Code-Specific Risks
- Misclassification if not confirmed by lab tests
Coding Notes
- Ensure laboratory confirmation of Group A Streptococcus to support coding.
B95.0 - Streptococcus, group A, as the cause of diseases classified elsewhere
Use as an additional code to specify the causative organism in streptococcal infections.
Applicable To
- Group A Streptococcus
Clinical Validation Requirements
- Laboratory confirmation of Group A Streptococcus
Coding Notes
Always used as an additional code to specify the infectious agent.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Streptococcus, group A, as the cause of diseases classified elsewhere
B95.0Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Strep Throat to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code J02.0.
Impact
Clinical: May lead to inappropriate treatment decisions., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims due to lack of specificity.
Mitigation Strategy
Ensure all test results are documented in the patient's chart., Use templates to guide thorough documentation.
Impact
Reimbursement: May result in lower reimbursement due to unspecified coding., Compliance: Non-compliance with coding guidelines for specificity., Data Quality: Reduces accuracy of clinical data.
Mitigation Strategy
Use J02.0 with B95.0 for confirmed cases.
Impact
Failure to include B95.0 when coding for streptococcal pharyngitis.
Mitigation Strategy
Implement checks to ensure B95.0 is added when J02.0 is used.
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 Strep Throat, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Strep Throat
Use these documentation templates to ensure complete and accurate documentation for Strep Throat. These templates include all required elements for proper coding and billing.
Emergency Department Visit for Sore Throat
Specialty: Emergency MedicineRequired Elements
- Patient history
- Physical examination findings
- Laboratory test results
- Diagnosis and treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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