2025 ICD-10-CM code J02.9
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Respiratory System Diagnosis - Acute upper respiratory infections Diseases of the respiratory system Feed
Acute pharyngitis, unspecified; inflammation of the pharynx (throat) with an undetermined cause.
Modifiers may be applicable depending on the specific circumstances of the encounter and services provided.Consult your local coding guidelines for further information.
Medical necessity is established by the presence of symptoms consistent with acute pharyngitis, such as sore throat, difficulty swallowing, and potential fever. The need for diagnostic testing to rule out more serious conditions is justifiable based on clinical presentation.
The clinical responsibility involves a thorough history taking, physical examination focusing on the pharynx, and potentially ordering diagnostic tests to rule out or confirm specific causes (e.g., rapid strep test, throat culture). If the cause is unclear, appropriate treatment for presumed pharyngitis will be provided.Further investigations might be necessary depending on clinical presentation.
- Diseases of the respiratory system
- J00-J99 (Diseases of the respiratory system) > J00-J06 (Acute upper respiratory infections)
In simple words: This code means the patient has a sore throat due to inflammation in the back of their throat, but the doctor doesn't know the exact reason for the inflammation yet.
Acute pharyngitis, unspecified (J02.9), is a diagnosis code used when a patient presents with inflammation of the pharynx (the back of the throat) but the specific cause remains undetermined after initial evaluation.The condition is characterized by a rapid onset of symptoms, often including sore throat, difficulty swallowing, throat redness and swelling, fever, swollen neck lymph nodes, headache, and fatigue. This code is used when more specific codes (e.g., for streptococcal pharyngitis) are not applicable.The code should be used cautiously and only when appropriate documentation supports the uncertainty of the causative agent.
Example 1: A 35-year-old presents with a sore throat, difficulty swallowing, and mild fever. Rapid strep test is negative, and throat culture is inconclusive. J02.9 is coded., A 10-year-old child has a sore throat, but the physician is unable to obtain a sufficient history to determine the etiology.J02.9 is appropriate., An adult patient presents with sore throat and other symptoms suggestive of a viral infection.After initial assessment, the cause is considered likely viral but remains unconfirmed. J02.9 is used for billing.
Detailed documentation in the physician's note is crucial, including patient history (onset, duration, associated symptoms), physical examination findings (throat examination, lymph node palpation), and results of any diagnostic tests (rapid strep test, throat culture). The reason for not using a more specific code must be clearly stated.
** Proper documentation is key to justify the use of this unspecified code.Always ensure the documentation supports the clinical uncertainty regarding the etiology of the pharyngitis.
- Payment Status: Active
- Modifier TC rule: Not applicable to this diagnostic code.
- Specialties:Family Medicine, Internal Medicine, Pediatrics, Otolaryngology
- Place of Service:Office, Urgent Care Facility, Emergency Room - Hospital, Inpatient Hospital, Outpatient Hospital