J35.03 — Chronic tonsillitis and adenoiditis
J35.03 is a billable, specific ICD-10-CM code for chronic tonsillitis and adenoiditis. It is valid for submission on a claim.
Other codes that can never be billed with J35.03
These codes carry an Excludes1 note pointing at J35.03. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading J35.03 alone.
- J35.3Hypertrophy of tonsils with hypertrophy of adenoids
Risk adjustment
J35.03 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.
Medicare coverage
J35.03 is named in 4 Medicare coverage policies — 4 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A57181Billing and Coding: Allergy Testing
- A57181Billing and Coding: Allergy Testing
- A57473Billing and Coding: Allergy Testing
- A57473Billing and Coding: Allergy Testing
How J35.03 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to J35.03.
- Adenoiditis›with tonsillitis
- Infection, infected, infective›lymphoid tissue, base of tongue or posterior pharynx, NEC(chronic)
- Infection, infected, infective›pharynx›posterior, lymphoid(chronic)
- Septic›tonsils, chronic›with adenoiditis
- Tonsillitis›chronic›with adenoiditis
- Tonsillitis›hypertrophic›with adenoiditis
Related codes at this level
Codes that share J35.0. If J35.03 is not quite right, the correct code is usually one of these.
Questions about J35.03
- Is J35.03 a billable ICD-10-CM code?
- Yes. J35.03 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does J35.03 sit in the tabular list?
- Diseases of the respiratory system (J00-J99), in the block Other diseases of upper respiratory tract (J30-J39).