ICD Code J03.90

ICD code J03.90 is used to classify a diagnosis of acute tonsillitis when the specific cause or type is not specified. This code is applied when a patient presents with symptoms of inflammation and infection of the tonsils, but the healthcare provider has not determined whether it is caused by a bacterial or viral infection. It allows for standardized documentation and billing for cases where the exact etiology of the tonsillitis remains unspecified.

1. Sore Throat: Persistent or severe sore throat that does not improve with initial treatment measures.

2. Red and Swollen Tonsils: Observation of redness and swelling in the tonsils, often accompanied by white or yellow patches.

3. Fever: Elevated body temperature, typically above 100.4°F (38°C), indicating an acute infection.

4. Difficulty Swallowing: Pain or discomfort when swallowing, often leading to reduced food and fluid intake.

5. Swollen Lymph Nodes: Tender or enlarged lymph nodes in the neck, which may be palpable during a physical examination.

6. Headache: Presence of headache, which can be a common symptom associated with acute infections.

7. Fatigue: General feeling of tiredness or lack of energy, often accompanying other symptoms.

8. Hoarseness or Loss of Voice: Changes in voice quality, including hoarseness or complete loss of voice, due to inflammation.

9. Bad Breath: Noticeable bad breath, which can occur due to bacterial infection in the throat.

10. Absence of Specific Pathogen Identification: When the specific pathogen causing the tonsillitis is not identified, leading to an unspecified diagnosis.

For the ICD code J03.90 (Acute tonsillitis, unspecified), the relevant CPT codes that may be applicable for treatment include:

1. CPT 42820 - Tonsillectomy and adenoidectomy; younger than age 12.

2. CPT 42821 - Tonsillectomy and adenoidectomy; age 12 or over.

3. CPT 42825 - Tonsillectomy, primary or secondary; younger than age 12.

4. CPT 42826 - Tonsillectomy, primary or secondary; age 12 or over.

5. CPT 99201-99215 - Evaluation and Management (E/M) codes for office or other outpatient visits, depending on the complexity and time spent with the patient.

These CPT codes are commonly associated with the treatment of conditions related to acute tonsillitis, such as surgical interventions and evaluation and management services. Always ensure proper documentation and coding practices are followed to align with the specific services provided.

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