Sore Throat ICD-10-CM Codes

What ICD-10 Codes are Used for Sore Throat 

Sore throat, known as pharyngitis, is commonly characterized by pain, scratchiness, or irritation. Viral or bacterial infections often cause it and can lead to discomfort while swallowing, speaking, or even breathing. A sore throat can also be a symptom of other underlying conditions such as allergies or acid reflux. 

Regarding medical coding, the International Classification of Diseases, Tenth Revision (ICD-10) provides specific codes for various conditions, including sore throat. Here are six commonly used ICD-10 codes for sore throat:

J02.0 - Streptococcal pharyngitis: 

This code is used for sore throats caused by infection with Streptococcus bacteria. It includes severe sore throat, swallowing pain, fever, and swollen tonsils.

J02.8 - Acute pharyngitis due to other specified organisms: 

This code is used when the sore throat is caused by organisms other than Streptococcus, such as viruses or other bacterial strains. It encompasses symptoms similar to streptococcal pharyngitis.

J31.2 - Chronic pharyngitis: 

This code is used when the sore throat persists for an extended period, typically over three months. Various factors, including postnasal drip, smoking, or irritant exposure, can cause chronic pharyngitis. Symptoms include a persistent sore throat, dryness, and a sensation of a lump in the throat.

J37.0 - Chronic laryngitis:

Although laryngitis primarily affects the voice box, it can also cause a sore throat. This code is used when the primary symptom is chronic laryngitis and a persistent sore throat. It is often caused by vocal strain, smoking, or gastroesophageal reflux.

J02.9 - Acute pharyngitis, unspecified: 

This code is used when the specific cause of acute pharyngitis or sore throat is not identified. It includes symptoms such as pain, inflammation, and discomfort in the throat, without specifying the underlying cause.

J00 - Acute nasopharyngitis (common cold): 

While not specific to sore throat, this code is used when acute nasopharyngitis (common cold) presents with a sore throat as one of its symptoms. It includes a runny or stuffy nose, sneezing, coughing, and a mild sore throat.

Which Sore Throat ICD codes are Billable: 

J02.0 - Streptococcal pharyngitis: 

Yes, this code is billable. Streptococcal pharyngitis is a specific diagnosis that requires appropriate treatment, such as antibiotics, and can be billed for reimbursement purposes.

J02.8 - Acute pharyngitis due to other specified organisms: 

Yes, this code is billable. It encompasses acute pharyngitis caused by organisms other than Streptococcus, such as viral or bacterial infections. Treatment and management may vary depending on the specific organism involved.

J31.2 - Chronic pharyngitis: 

Yes, this code is billable. Chronic pharyngitis refers to a persistent inflammation of the pharynx, and it requires ongoing management and treatment. The code allows for appropriate reimbursement for the continued care provided.

J37.0 - Chronic laryngitis: 

Yes, this code is billable. While chronic laryngitis primarily affects the voice box, it can cause a persistent sore throat as a symptom. It requires ongoing evaluation and management, which can be billed for reimbursement.

J02.9 - Acute pharyngitis, unspecified: 

Yes, this code is billable. Although it represents unspecified acute pharyngitis, it still indicates the need for evaluation and treatment. It allows for billing purposes but lacks specificity regarding the underlying cause.

J00 - Acute nasopharyngitis (common cold): 

No, this code is not billable for a sore throat. Acute nasopharyngitis (common cold) is primarily associated with upper respiratory symptoms, including a runny or stuffy nose, sneezing, and coughing. While a sore throat can be present, it is not the primary focus of this code.

Clinical Information

Accurate coding of the sore throat using the appropriate ICD-10-CM codes helps healthcare providers document the condition's specific nature and cause. The following information is essential for proper medical record-keeping, billing, and research purposes:

• Sore throat, also known as pharyngitis, can be classified using specific ICD-10-CM codes for accurate documentation and billing purposes.
• The primary code for sore throat is J02.9, which represents acute pharyngitis, unspecified. This code is used when the exact cause of the sore throat is not specified.
• If the sore throat is attributed to a viral infection, the code J02.0 is used for streptococcal sore throat. It indicates an acute infection caused by streptococcal bacteria.
• For sore throats caused by other specified organisms, the code J02.8 is utilized. This code covers cases where the specific organism causing the infection is identified, such as Epstein-Barr virus (J02.81) or coxsackievirus (J02.83).
• In cases where a chronic or persistent sore throat is diagnosed, the code J31.2 is used for chronic pharyngitis. This code denotes ongoing inflammation of the pharynx that lasts for an extended period.
• If the sore throat is due to gastroesophageal reflux disease (GERD), the code K21.9 is assigned for gastroesophageal reflux disease without esophagitis. A GERD-related sore throat can occur due to acid reflux irritating the throat.

Synonyms Include:

• Pharyngitis
• Acute throat infection
• Tonsillopharyngitis
• Soreness of the throat
• Throat inflammation
• Throat pain
• Pharyngeal discomfort
• Oropharyngeal irritation
• Strep throat
• Irritated throat