J03
J03 — Acute tonsillitis
Non-billable headerICD-10-CM
J03 is a non-billable header ICD-10-CM code for acute tonsillitis. It cannot be billed on its own: choose one of the more specific child codes below.
Excludes1 — never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
Excludes2 — not included here, but may coexist
The excluded condition is not part of this code, but a patient can have both. You may code both.
- chronic tonsillitis (J35.0)
Other codes that can never be billed with J03
These codes carry an Excludes1 note pointing at J03. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading J03 alone.
Risk adjustment
J03 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Code to one of these instead J03
3 child codes. Green means billable.
Questions about J03
- Is J03 a billable ICD-10-CM code?
- No. J03 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
- Where does J03 sit in the tabular list?
- Diseases of the respiratory system (J00-J99), in the block Acute upper respiratory infections (J00-J06).
- What cannot be coded together with J03?
- J03 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.