2025 ICD-10-CM code J02.0
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Infectious Diseases - Acute upper respiratory infections (J00-J06) Diseases of the respiratory system (J00-J99) Feed
Streptococcal pharyngitis, also known as strep throat, is a bacterial infection of the throat caused by Streptococcus bacteria.
ICD-10 codes do not utilize modifiers. Modifiers are used with procedural codes like CPT and HCPCS codes.
Medical necessity for the diagnosis and treatment of streptococcal pharyngitis is established by the presence of symptoms suggestive of a bacterial throat infection confirmed by a positive rapid strep test or throat culture.Treatment with antibiotics is medically necessary to prevent complications, such as rheumatic fever or glomerulonephritis.
The clinical responsibility lies with the physician or other qualified healthcare professional who diagnoses and manages the patient's strep throat.This includes performing a physical examination, ordering and interpreting diagnostic tests (rapid strep test or throat culture), and prescribing and monitoring treatment (antibiotics).
- Diseases of the respiratory system (J00-J99)
- J00-J99 (Diseases of the respiratory system) > J00-J06 (Acute upper respiratory infections)
In simple words: Strep throat is a bacterial infection in your throat.It causes a sore throat, trouble swallowing, and sometimes a fever.Doctors usually diagnose it with a quick test and treat it with antibiotics.
Streptococcal pharyngitis (J02.0) is an acute infection of the pharynx caused by Streptococcus pyogenes bacteria.It is characterized by a sudden onset of pharyngeal inflammation, typically manifesting as a sore throat, difficulty swallowing, redness and swelling of the throat, and sometimes fever.Diagnosis is usually made through clinical examination and confirmed with a rapid antigen detection test or throat culture.Treatment typically involves antibiotic therapy, such as penicillin or amoxicillin.
Example 1: A 6-year-old presents with a sore throat, fever, and difficulty swallowing.A rapid strep test confirms Streptococcus pyogenes infection.The physician diagnoses streptococcal pharyngitis (J02.0) and prescribes penicillin., A 25-year-old college student reports a severe sore throat, headache, and body aches.A throat culture confirms group A streptococcal infection. The physician diagnoses streptococcal pharyngitis (J02.0) and prescribes amoxicillin, advising rest and increased fluid intake., A 40-year-old adult presents with a sore throat, headache and fever for the past 2 days. Physical examination reveals enlarged and tender anterior cervical lymph nodes and erythematous pharynx with tonsillar exudates.Rapid strep test is positive. The physician diagnoses strep throat (J02.0) and prescribes azithromycin.
Documentation should include the patient's symptoms (sore throat, difficulty swallowing, fever, etc.), the results of the rapid strep test or throat culture confirming the presence of Streptococcus pyogenes, the diagnosis of streptococcal pharyngitis, and the prescribed treatment (antibiotics).The physician's assessment and plan should also be documented.
** Accurate documentation is critical for selecting the correct code.If the documentation does not specify the causative organism, use J02.9 (Acute pharyngitis, unspecified).Always verify the code against the official ICD-10-CM coding guidelines to ensure compliance.
- Revenue Code: Revenue codes will vary depending on the payer and the specific services provided.Consult your payer's guidelines for appropriate revenue code selection.
- RVU: RVUs are not directly associated with ICD-10 codes. RVUs are associated with CPT codes which represent procedures and services.
- Global Days : Not applicable to ICD-10 codes.
- Payment Status: Active
- Modifier TC rule: Not applicable to ICD-10 codes.
- Fee Schedule : Not applicable to ICD-10 codes. Fee schedules are associated with procedural codes (CPT and HCPCS).
- Specialties:Family Medicine, Pediatrics, Internal Medicine, Otolaryngology
- Place of Service:Office, Urgent Care Facility, Hospital Inpatient, Hospital Outpatient