ICD-10 Coding for Throat Swelling(J02.0, T78.3XXA, R22.1)
Complete ICD-10-CM coding and documentation guide for Throat Swelling. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Throat Swelling
J02-J03Primary Range
Acute pharyngitis and tonsillitis
Covers infectious causes of throat swelling, including streptococcal pharyngitis.
Localized swelling, mass and lump of skin and subcutaneous tissue
Used for non-specific throat swelling when the etiology is unknown.
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 infection is confirmed by testing. |
|
| T78.3XXA | Angioedema, initial encounter | Use for allergic reactions causing throat swelling, confirmed by clinical findings. |
|
| R22.1 | Localized swelling, mass and lump of skin and subcutaneous tissue, neck | Use when the cause of swelling is unknown or non-specific. |
|
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 throat swelling
Essential facts and insights about Throat Swelling
Primary ICD-10-CM Codes for throat swelling
Decision Criteria
clinical Criteria
- Presence of tonsillar exudate and tender cervical nodes
Applicable To
- Strep throat
Excludes
- Acute sore throat NOS (J02.9)
Clinical Validation Requirements
- Positive rapid strep test (87880)
- Culture-confirmed Group A Streptococcus
Code-Specific Risks
- Incorrectly using for viral pharyngitis
Coding Notes
- Ensure documentation specifies the presence of streptococcal infection.
T78.3XXA - Angioedema, initial encounter
Use for allergic reactions causing throat swelling, confirmed by clinical findings.
Applicable To
- Allergic angioedema
Excludes
- Hereditary angioedema (D84.1)
Clinical Validation Requirements
- Documentation of allergen exposure
- C4 complement levels <15 mg/dL
Coding Notes
Ensure documentation includes specific allergen or drug exposure.
R22.1 - Localized swelling, mass and lump of skin and subcutaneous tissue, neck
Use when the cause of swelling is unknown or non-specific.
Excludes
- Swelling due to infection (J02.0, J03.0)
- Angioedema (T78.3XXA)
Clinical Validation Requirements
- Ultrasound or MRI showing localized edema without infection
Coding Notes
Ensure no infectious or allergic cause is documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Throat Swelling 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, Regulatory: Non-compliance with coding standards, Financial: Potential for claim denials
Mitigation Strategy
Ensure documentation supports specific code selection, Use decision criteria to guide code choice
Impact
Reimbursement: Incorrect DRG assignment, Compliance: Potential for audit failure, Data Quality: Inaccurate clinical data
Mitigation Strategy
Code J02.0 when exudate/Centor criteria present
Impact
Reimbursement: May affect reimbursement for allergy-related treatments, Compliance: Non-compliance with coding guidelines, Data Quality: Loss of specific clinical data
Mitigation Strategy
Specify 'Anaphylaxis WITH laryngeal edema (T78.2XXA)'
Impact
Failure to document specific etiology can lead to incorrect coding.
Mitigation Strategy
Implement thorough documentation practices and regular coding audits.
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 Throat Swelling, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Throat Swelling
Use these documentation templates to ensure complete and accurate documentation for Throat Swelling. These templates include all required elements for proper coding and billing.
Emergency Department Note (Angioedema)
Specialty: Emergency MedicineRequired Elements
- HPI
- Exam findings
- Assessment
- Plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Primary Care Note (Infectious)
Specialty: Family MedicineRequired Elements
- HPI
- Exam findings
- Labs
- Assessment
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Throat Swelling? Ask your questions below.