2025 ICD-10-CM code J35.1
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Diseases of the respiratory system - Other diseases of upper respiratory tract (J30-J39) Diseases of the respiratory system (J00-J99) Feed
Hypertrophy of tonsils; enlargement of the tonsils.
Medical necessity for treatment of tonsil hypertrophy (J35.1) is established when the enlargement causes clinically significant symptoms, such as difficulty breathing, swallowing, sleep apnea, or recurrent infections that do not respond to conservative management.Documentation should clearly demonstrate the impact of the hypertrophy on the patient's quality of life and functional capacity to justify medical intervention.
The clinical responsibility for managing a patient with J35.1 (tonsil hypertrophy) falls upon an otolaryngologist (ENT specialist) or a primary care physician. The physician's duties include performing a thorough physical examination, assessing symptoms such as breathing difficulties or sleep apnea, ordering appropriate investigations (e.g., imaging studies if necessary), and deciding on the course of management, ranging from conservative treatment (e.g., medication, watchful waiting) to surgical intervention (tonsillectomy) based on the severity of the condition and patient's clinical presentation.
In simple words: J35.1 is a medical code for enlarged tonsils.The tonsils are located at the back of your throat and help fight infection. If they get too big, it can make it hard to breathe, swallow, or sleep.
J35.1 in the ICD-10-CM coding system represents hypertrophy of the tonsils, signifying an enlargement of these lymphoid tissues located at the back of the throat.This condition can manifest in various degrees of severity, impacting swallowing, breathing, and potentially leading to sleep apnea or recurrent infections.The etiology can be multifaceted, ranging from chronic infections and allergies to genetic predispositions. Diagnosis typically involves a physical examination, supplemented by imaging studies in certain cases to assess the size and extent of tonsillar enlargement.
Example 1: A 5-year-old child presents with recurrent tonsillitis and persistent mouth breathing.Physical examination reveals significantly enlarged tonsils.The physician diagnoses tonsil hypertrophy (J35.1) and initiates conservative management with antibiotics for infection and monitors for further complications., A 30-year-old adult complains of snoring and daytime sleepiness.A sleep study reveals obstructive sleep apnea, attributed to enlarged tonsils.The physician codes this as J35.1 (tonsil hypertrophy) along with a sleep apnea diagnosis code and considers a tonsillectomy., A teenager presents with a chronic sore throat and difficulty swallowing.Examination reveals significantly enlarged tonsils. The physician diagnoses J35.1 and after excluding other causes through a physical exam and blood tests considers a tonsillectomy to address the hypertrophy and associated symptoms.
Detailed history and physical examination findings, including documentation of the size of the tonsils.If imaging studies are performed (e.g., CT scan), include these reports in the medical record.Documentation should also reflect clinical indications of surgical removal (e.g., obstructive sleep apnea, recurrent tonsillitis).
** While J35.1 focuses on hypertrophy, it's crucial to distinguish it from tonsillitis (inflammation).Appropriate additional codes should be used to clarify co-morbidities or concurrent conditions.
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- Specialties:Otolaryngology, Pediatrics
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