ICD-10 Coding for Swollen Tonsils(J35.1, J35.2)
Complete ICD-10-CM coding and documentation guide for Swollen Tonsils. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Swollen Tonsils
J35-J36Primary Range
Chronic diseases of tonsils and adenoids
This range includes codes for chronic conditions affecting the tonsils, such as hypertrophy and chronic tonsillitis.
Acute tonsillitis
This range is used for acute infections of the tonsils, which may present similarly to chronic conditions.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| J35.1 | Hypertrophy of tonsils | Use when tonsils are enlarged without signs of acute infection. |
|
| J35.2 | Hypertrophy of tonsils with sore throat | Use when tonsils are enlarged and sore throat is present without acute infection. |
|
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 swollen tonsils
Essential facts and insights about Swollen Tonsils
Primary ICD-10-CM Codes for swollen tonsils
Decision Criteria
clinical Criteria
- Tonsils enlarged without acute symptoms
Applicable To
- Enlarged tonsils
Excludes
- Acute tonsillitis (J03.-)
Clinical Validation Requirements
- Tonsil size grading (e.g., Brodsky scale)
- Absence of exudate/erythema
Code-Specific Risks
- Confusion with acute tonsillitis codes
Coding Notes
- Ensure documentation specifies hypertrophy without acute symptoms.
J35.2 - Hypertrophy of tonsils with sore throat
Use when tonsils are enlarged and sore throat is present without acute infection.
Applicable To
- Enlarged tonsils with pain
Excludes
- Acute tonsillitis (J03.-)
Clinical Validation Requirements
- Pain duration >48 hours
- Tonsil grading
- Absence of strep/other infection
Coding Notes
Document sore throat duration and severity.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Swollen Tonsils to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code J35.1.
Impact
Clinical: Misdiagnosis risk., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Ensure detailed symptom documentation., Use standardized scales for assessment.
Impact
Reimbursement: Incorrect DRG assignment may reduce reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use J35.2 if sore throat is present.
Impact
Inadequate documentation of sore throat symptoms when coding J35.2.
Mitigation Strategy
Ensure thorough documentation of symptom duration and severity.
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 Swollen Tonsils, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Swollen Tonsils
Use these documentation templates to ensure complete and accurate documentation for Swollen Tonsils. These templates include all required elements for proper coding and billing.
ENT Consultation for Tonsillar Hypertrophy
Specialty: OtolaryngologyRequired Elements
- Subjective symptoms
- Objective findings
- Assessment
- Plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Swollen Tonsils? Ask your questions below.