CODES.AND.STUFF

Acute tonsillitis is inflammation of the tonsillar tissue, which may be viral or bacterial in origin.

Recurrent tonsillitis refers to multiple distinct episodes of acute tonsillitis. Each presentation should be diagnosed and documented using the same criteria as for acute tonsillitis. Specific management of each episode will be determined by the suspected aetiology (viral or bacterial).

Chronic tonsillitis is an ill-defined entity, which may be associated with foci of bacteria deep in tonsillar tissue. It is characterized by persistent signs and symptoms of low-grade infection, including sore throat, malaise and abnormal tonsillar appearance. Consideration should be given to aggressive oral antibiotic therapy, but each individual case will merit specific management strategies.

The UK Coding Review Panel has sought clinical input regarding the coding of tonsillitis. The advice given was that acute tonsillitis is sometimes a reason for emergency admission to hospital, chronic tonsillitis almost never is.

Admissions to hospital for elective tonsillectomy are most commonly for recurrent acute tonsillitis.

Example 1:

Diagnosis: Tonsillitis

Index Trail:

Tonsillitis (acute) (follicular) (gangrenous) (infective) (lingual) (septic) (subacute) (ulcerative) J03.9

Tabular:

J03.9 Acute tonsillitis, unspecified

When a diagnostic statement is described as a single term which has no modifiers, it is said to be unspecified or NOS (not otherwise specified). The code assignment is that which follows the lead term.

Example 2:

Diagnosis: Tonsillitis (acute)

Index Trail:

Tonsillitis (acute) (follicular) (gangrenous) (infective) (lingual) (septic) (subacute) (ulcerative) J03.9

Tabular List:

J03.9 Acute tonsillitis, unspecified

Example 3:

Diagnosis: Chronic tonsillitis

Index Trail:

Tonsillitis (acute) (follicular) (gangrenous) (infective) (lingual) (septic) (subacute) (ulcerative) J03.9

– chronic J35.0

Tabular:

J35.0 Chronic tonsillitis

In this scenario chronic is an essential modifier and therefore must be present in the diagnostic statement to be able to assign J35.0 Chronic tonsillitis. When following the four step coding process it is important to note the excludes note at J35.0, which excludes tonsillitis NOS and directs the coder to assign a code of J03.9.

Example 4:

Diagnosis: Recurrent tonsillitis

Index Trail:

Tonsillitis (acute) (follicular) (gangrenous) (infective) (lingual) (septic) (subacute) (ulcerative) J03.9

Tabular List:

J03.9 Acute tonsillitis, unspecified

There is no essential modifier for ‘recurrent’ therefore the index trail for tonsillitis leads to J03.9 Acute tonsillitis, unspecified which includes Tonsillitis (acute).

Update history

12/2011: Unnecessary ICD-10 index trails and OPCS-4 codes have been removed to make the guidance more concise.

Date first published: 10/2005 (Volume 2 Issue 2)

Coding Clinic, NHS Classifications Service

www.connectingforhealth.nhs.uk/codingclinic

Related articles

• Too few tonsillectomies ‘risks health’ (bbc.co.uk)

Tags: respiratory system, tonsillitis