Is J35.1 a billable ICD-10-CM code?

Yes. J35.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does J35.1 sit in the tabular list?

Diseases of the respiratory system (J00-J99), in the block Other diseases of upper respiratory tract (J30-J39).

What cannot be coded together with J35.1?

J35.1 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

J35.1

J35.1 — Hypertrophy of tonsils

Billable / specific codeICD-10-CM

J35.1 is a billable, specific ICD-10-CM code for hypertrophy of tonsils. It is valid for submission on a claim.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

hypertrophy of tonsils with tonsillitis (J35.0-)

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Enlargement of tonsils

Other codes that can never be billed with J35.1

These codes carry an Excludes1 note pointing at J35.1. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading J35.1 alone.

J03Acute tonsillitis

Risk adjustment

J35.1 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

J35.1 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 J35.1 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 J35.1.

Enlargement, enlarged›tonsils
Hyperplasia, hyperplastic›tonsils(faucial) (infective) (lingual) (lymphoid)
Hypertrophy, hypertrophic›lingual tonsil(infective)
Hypertrophy, hypertrophic›tonsils(faucial) (infective) (lingual) (lymphoid)

Related codes at this level

Codes that share J35. If J35.1 is not quite right, the correct code is usually one of these.

Questions about J35.1

Is J35.1 a billable ICD-10-CM code?: Yes. J35.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does J35.1 sit in the tabular list?: Diseases of the respiratory system (J00-J99), in the block Other diseases of upper respiratory tract (J30-J39).
What cannot be coded together with J35.1?: J35.1 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.