Is J35.3 a billable ICD-10-CM code?

Yes. J35.3 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does J35.3 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 J35.3?

J35.3 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

J35.3

J35.3 — Hypertrophy of tonsils with hypertrophy of adenoids

Billable / specific codeICD-10-CM

J35.3 is a billable, specific ICD-10-CM code for hypertrophy of tonsils with hypertrophy of adenoids. 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 and adenoids with tonsillitis and adenoiditis (J35.03)

Risk adjustment

J35.3 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

J35.3 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 J35.3 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 J35.3.

Enlargement, enlarged›adenoids›with tonsils
Enlargement, enlarged›tonsils›with adenoids
Hyperplasia, hyperplastic›tonsils›with adenoids
Hypertrophy, hypertrophic›adenoids›with tonsils
Hypertrophy, hypertrophic›lingual tonsil›with adenoids
Hypertrophy, hypertrophic›tonsils›with adenoids

Related codes at this level

Codes that share J35. If J35.3 is not quite right, the correct code is usually one of these.

Questions about J35.3

Is J35.3 a billable ICD-10-CM code?: Yes. J35.3 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does J35.3 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 J35.3?: J35.3 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.