Taking the tenth spot in the top ten diagnosis codes worked up in the emergency department and coded by web2pro includes acute pharyngitis or sore throat (462) another very common presentation in the emergency department.

Pharyngitis is inflammation of the pharynx – the back of the throat. Although usually viral in origin (such as the common cold, influenza, or mononucleosis), pharyngitis may be due to a bacterial infection, which is less common than the viral type. The most common type of bacterial infection is strep throat, which is caused by streptococcus A, and rare causes of bacterial pharyngitis include gonorrhea, Chlamydia, and corynebacterium.

When the physician examines a patient with a sore throat, it is difficult to differentiate viral from bacterial infections as both are associated with discomfort or pain and fever, and cervical adenopathy (i.e., swollen lymph nodes) may also be present. Typically, a viral infection is associated with sore throat, cold, flu that may cause runny nose, headache, cough, and low grade fever. A bacterial infection is typically associated with swollen lymph nodes, general malaise, and a loss of appetite.

Viral infections do not respond to antibiotics, and some of the treatment is only necessary to help relieve symptoms. Treatment would include acetaminophen for the discomfort and rest. If there is clinical evidence suggesting a bacterial infection, antibiotics are the typical route of therapy. The physician may order throat cultures to determine whether or not Group A streptococcus is found in the study.

There is a one-to-one crosswalk for acute pharyngitis, but there are other types of pharyngitis, depending on whether viral or bacterial, as outlined in the below table.

  Medical Code Acute Pharyngitis

As mentioned above, treatment for pharyngitis depends on the patient’s type of pharyngitis. The vast majority of pharyngitis cases will be instructed to take over the counter medications for pain and fever, drink plenty of fluids, gargle with warm salt water, and rest until you feel better. 

Pharyngitis codes are located in several sections of ICD-9/ICD-10 depending on the type of pharyngitis diagnosed.    

As you can see in the above table there are a number of ICD-10 codes for pharyngitis, and this is only a small example of those in both ICD-9 and ICD-10 books. It is imperative that the provider document exactly what the examination and the diagnostic studies’ findings are, if any, to determine the exact course of action for the condition presented or defined after study.

ICD-10-CM, 2013 Complete Draft Code Set, Chapter 10, Diseases of the Respiratory System, AAPC, Optuminsight 2012.

ICD-9-CM, 2014, Sixth Edition, 9th revision, Diseases of the Respiratory System Chapter 8, and Infectious and Parasitic Diseases, Chapter 1. Editor – Anita C. Hart, Optuminsight August 2013.

Merck Manual, Section 7, Page 690 Ear, Nose and Throat Disorders. Keryn A.G. Lane, Publisher – Gary Zelko, June 1999.  

Merit-based Incentive Payment System (MIPS) Final Rule
Author - Male

About the author

Robert Bunting, CPC, CPC-H, CHC, CEDC, CEMC, CAC is Compliance Director – Emergency Medicine, web2pro Business Performance Services.