Suppose a patient comes in with multiple symptoms of strep throat, such as sore throat and difficulty swallowing. In that case, it is hard to distinguish the proper codes to use to bill insurance companies and have exact records on file of what the diagnosis was. That's where ICD codes factor in. International Classification of Diseases (ICD) codes serve as a broad range of unique identifiers that provide crucial knowledge on different diseases' extent, causes, and outcomes. Used globally, ICD codes are the primary basis for all health recording and death certificates and are used for insurance billing and disease management.

What is ICD-10?

ICD codes are found on all patient paperwork, visit summaries, hospital records, medical charts, and bills. These codes were designed to ensure each patient gets proper treatment and is charged accurately for any medical services they receive. 

Maintained by the World Health Organization (WHO), ICD-10 is considered the 10th version of the code and has been used since 2015. It contains more than 70,000 disease codes for all 27 participating countries. Each year, updates and revisions are made to the previous version.  Although ICD-11 was introduced at the beginning of 2022, every state is to continue to use ICD-10 through September 30, 2022. In the United States, ICD codes are overseen by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS). Having the correct code is vital to ensure that standardized treatment for a medical issue is delivered and reimbursed for medical expenses.  

What is the Right Code for Strep Throat?

The ICD-10-CM Alphabetical Index was designed to allow medical coders to look up various medical terms and connect them with the appropriate ICD codes. There are four terms under the parent term 'Streptococcus' in the index. The correct ICD-10 code for strep (Streptococcal pharyngitis) is J02.0, effective from October 1, 2021, through September 30, 2022. 

Streptococcal pharyngitis is an infection of the back of the throat, including the tonsils, caused by group A streptococcus. Common symptoms include fever, sore throat, inflamed tonsils, and enlarged lymph nodes. This is where the coding can get tricky, however. If a patient has multiple symptoms of strep, you must be certain that the strep test was, in fact, positive to use this code for billing. A rapid strep test will provide results in under 10 minutes so that you can bill accordingly.

ICD-10 Code J02.0 Can Only Be Used If the Following Occurs:

• Septic pharyngitis
• Streptococcal pharyngitis/sore throat

This code excludes Scarlet Fever, a common side effect if strep is not treated. If a strep throat test is negative, this code should not be used. ICD-10 allows you to report signs or symptoms (R00-R99) when you have not yet established or confirmed a related definitive diagnosis. Typically, you would report J02.9 (Acute pharyngitis) to reflect the patient’s chief complaint of a sore throat, which the ICD considers to be a definitive diagnosis rather than a symptom. Acute Tonsillitis would fall under J03.00, J03.01, J03.80, J03.81, J03.90, or J03.91.

Using the correct code is not only essential for diagnosis and statistics, but they must also align with the insurance company for proper billing. Treatments, symptoms, and tests must match the standard ICD code. If the two codes don't match, the insurance company may deny payment. Coding can get complicated, but your codes will all match if you use the index correctly. 

Written by: Ali Kessler