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ICD-10 Coding for Streptococcal Sore Throat(J02.0, J03.00)

Complete ICD-10-CM coding and documentation guide for Streptococcal Sore Throat. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

Strep ThroatStreptococcal PharyngitisStreptococcal Tonsillitis

Related ICD-10 Code Ranges

Complete code families applicable to Streptococcal Sore Throat

J02-J03Primary Range

Acute pharyngitis and tonsillitis

This range includes codes for acute pharyngitis and tonsillitis, which are relevant for coding streptococcal infections of the throat.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
J02.0Acute streptococcal pharyngitisUse when there is confirmed streptococcal infection of the pharynx.
  • Positive rapid antigen detection test (RADT) or throat culture
  • Symptoms such as fever, tender anterior cervical lymph nodes, and absence of cough
J03.00Acute streptococcal tonsillitisUse when the infection involves the tonsils and is confirmed as streptococcal.
  • Positive RADT or throat culture
  • Tonsillar exudate and swelling

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 streptococcal sore throat

Essential facts and insights about Streptococcal Sore Throat

The ICD-10 code for streptococcal sore throat is J02.0, representing acute streptococcal pharyngitis.

Primary ICD-10-CM Codes for streptococcal sore throat

Acute streptococcal pharyngitis
Billable Code

Decision Criteria

clinical Criteria

  • Presence of positive RADT or culture confirming streptococcal infection

documentation Criteria

  • Explicit mention of 'streptococcal pharyngitis' in the medical record

Applicable To

  • Streptococcal sore throat

Excludes

  • Acute tonsillitis (J03.-)

Clinical Validation Requirements

  • Positive rapid antigen detection test (RADT) or throat culture
  • Symptoms such as fever, tender anterior cervical lymph nodes, and absence of cough

Code-Specific Risks

  • Using this code without confirmed bacterial infection can lead to denials.

Coding Notes

  • Ensure documentation specifies 'streptococcal' and includes positive test results.

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

B95.5
Use as an additional code to identify the organism when relevant.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Acute pharyngitis, unspecified

J02.9
Use J02.9 when the cause of pharyngitis is not specified or confirmed as streptococcal.

Acute tonsillitis, unspecified

J03.90
Use J03.90 when the cause of tonsillitis is not specified or confirmed as streptococcal.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Streptococcal Sore 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: Leads to inappropriate treatment., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.

Mitigation Strategy

Ensure specific diagnosis is documented., Confirm test results before coding.

Impact

Reimbursement: Denials due to incorrect coding., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.

Mitigation Strategy

Ensure bacterial confirmation before coding.

Impact

Using J02.0 without confirmed streptococcal infection.

Mitigation Strategy

Require documentation of positive test results.

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 Streptococcal Sore Throat, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Streptococcal Sore Throat

Use these documentation templates to ensure complete and accurate documentation for Streptococcal Sore Throat. These templates include all required elements for proper coding and billing.

Acute streptococcal pharyngitis in a pediatric patient

Specialty: Pediatrics

Required Elements

  • Patient history
  • Physical examination findings
  • Test results
  • Treatment plan

Example Documentation

14yo F presents with 2-day history of sore throat, fever, no cough. RADT positive. Prescribed amoxicillin.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Sore throat, strep test done.
Good Documentation Example
Acute streptococcal pharyngitis confirmed by positive RADT, treated with amoxicillin.
Explanation
The good example specifies the diagnosis, test confirmation, and treatment.

Need help with ICD-10 coding for Streptococcal Sore Throat? Ask your questions below.

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