ICD-10-CM Code For Acute Tonsillitis: Group Overview

The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code group J03 includes acute tonsillitis diagnoses, covering infectious inflammation of the tonsils including streptococcal and other bacterial or viral causes, with codes distinguishing laterality and chronicity when applicable. These ICD-10-CM diagnosis codes are used to document clinical encounters for acute tonsillar infections, capturing features such as unilateral or bilateral involvement and presence of complications like abscess. Accurate coding within the ICD-10-CM J03 group supports proper claim adjudication, complete clinical documentation, and appropriate reimbursement.

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ICD-10-CM J03: Acute Tonsillitis Overview

The ICD-10-CM J03 group covers acute inflammation of the palatine tonsils, typically due to infectious causes affecting the oropharynx. These diagnoses target the upper respiratory and lymphoid tissues in the throat and reflect varying severity and laterality. Accurate coding matters for correct clinical records and supports appropriate reimbursement by reflecting the specific clinical presentation.

When to Use

Use codes from this group when the clinical documentation indicates an acute tonsillar infection as the primary diagnosis for the encounter, including specified laterality or infectious organism when documented. Select more specific codes when complications or abscess formation are present to reflect clinical severity and support accurate billing.

ICD-10-CM Codes

6 rows

ICD-10-CM Code	Description
J03.00	Acute streptococcal tonsillitis, unspecified
J03.01	Acute recurrent streptococcal tonsillitis
J03.80	Acute tonsillitis due to other specified organisms
J03.81	Acute recurrent tonsillitis due to other specified organisms
J03.90	Acute tonsillitis, unspecified
J03.91	Acute recurrent tonsillitis, unspecified

DRG Codes

5 rows

DRG Code	Description
011	Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with MCC
012	Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with CC
013	Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy without CC/MCC
152	Otitis Media and URI with MCC
153	Otitis Media and URI without MCC

Typical Clinical Scenarios

A pediatric patient presents to urgent care with sudden onset sore throat, high fever (39.5°C), difficulty swallowing, and visibly enlarged, erythematous tonsils with purulent exudate. Rapid antigen detection test for group A strep is positive, prompting a diagnosis of acute bacterial tonsillitis and initiation of appropriate therapy; this is an acute infectious presentation in a child. Typical codes: J03.01, J03.00
An adult outpatient develops sudden severe throat pain and fever after a recent upper respiratory viral illness; examination shows markedly swollen, erythematous tonsils without documented exudate, and no rapid strep test performed. The clinician documents acute tonsillitis of unspecified etiology during the acute visit for symptomatic management. Typical codes: J03.90, J03.91
A patient with recurrent tonsillitis presents to the emergency department with severe unilateral throat pain, trismus, muffled voice, and peritonsillar swelling suggestive of a peritonsillar abscess complicating acute tonsillar infection; they require incision and drainage and hospital observation. Because the presentation represents an acute tonsillar infection complicated by a localized suppurative process, an acute tonsillitis code that denotes a specific organism when identified or a nonspecific acute code if not identified is assigned. Typical codes: J03.80, J03.81

Related Codes

J00-ACUTE-NASOPHARYNGITIS-COMMON-COLD

ICD-10-CM Code For Acute Nasopharyngitis Common Cold: Group Overview

J01-ACUTE-SINUSITIS

ICD-10-CM Code For Acute Sinusitis: Group Overview

J02-ACUTE-PHARYNGITIS

ICD-10-CM Code For Acute Pharyngitis: Group Overview

J04-ACUTE-LARYNGITIS-AND-TRACHEITIS

ICD-10-CM Code For Acute Laryngitis And Tracheitis: Group Overview

J05-ACUTE-OBSTRUCTIVE-LARYNGITIS-AND-EPIGLOTTITIS

ICD-10-CM Code For Acute Obstructive Laryngitis And Epiglottitis: Group Overview

J06-ACUTE-UPPER-RESPIRATORY-INFECTIONS

ICD-10-CM Code For Acute Upper Respiratory Infections Of Multiple And Unspecified Sites: Group Overview

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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When to Use

ICD-10-CM Codes

6 rows

ICD-10-CM Code	Description
J03.00	Acute streptococcal tonsillitis, unspecified
J03.01	Acute recurrent streptococcal tonsillitis
J03.80	Acute tonsillitis due to other specified organisms
J03.81	Acute recurrent tonsillitis due to other specified organisms
J03.90	Acute tonsillitis, unspecified
J03.91	Acute recurrent tonsillitis, unspecified

DRG Codes

5 rows

DRG Code	Description
011	Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with MCC
012	Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with CC
013	Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy without CC/MCC
152	Otitis Media and URI with MCC
153	Otitis Media and URI without MCC

Typical Clinical Scenarios

A pediatric patient presents to urgent care with sudden onset sore throat, high fever (39.5°C), difficulty swallowing, and visibly enlarged, erythematous tonsils with purulent exudate. Rapid antigen detection test for group A strep is positive, prompting a diagnosis of acute bacterial tonsillitis and initiation of appropriate therapy; this is an acute infectious presentation in a child. Typical codes: J03.01, J03.00
An adult outpatient develops sudden severe throat pain and fever after a recent upper respiratory viral illness; examination shows markedly swollen, erythematous tonsils without documented exudate, and no rapid strep test performed. The clinician documents acute tonsillitis of unspecified etiology during the acute visit for symptomatic management. Typical codes: J03.90, J03.91
A patient with recurrent tonsillitis presents to the emergency department with severe unilateral throat pain, trismus, muffled voice, and peritonsillar swelling suggestive of a peritonsillar abscess complicating acute tonsillar infection; they require incision and drainage and hospital observation. Because the presentation represents an acute tonsillar infection complicated by a localized suppurative process, an acute tonsillitis code that denotes a specific organism when identified or a nonspecific acute code if not identified is assigned. Typical codes: J03.80, J03.81

Related Codes

J00-ACUTE-NASOPHARYNGITIS-COMMON-COLD

ICD-10-CM Code For Acute Nasopharyngitis Common Cold: Group Overview

J01-ACUTE-SINUSITIS

ICD-10-CM Code For Acute Sinusitis: Group Overview

J02-ACUTE-PHARYNGITIS

ICD-10-CM Code For Acute Pharyngitis: Group Overview

J04-ACUTE-LARYNGITIS-AND-TRACHEITIS

ICD-10-CM Code For Acute Laryngitis And Tracheitis: Group Overview

J05-ACUTE-OBSTRUCTIVE-LARYNGITIS-AND-EPIGLOTTITIS

ICD-10-CM Code For Acute Obstructive Laryngitis And Epiglottitis: Group Overview

J06-ACUTE-UPPER-RESPIRATORY-INFECTIONS

ICD-10-CM Code For Acute Upper Respiratory Infections Of Multiple And Unspecified Sites: Group Overview

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

ICD-10-CM Code For Acute Tonsillitis: Group Overview

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ICD-10-CM J03: Acute Tonsillitis Overview

ICD-10-CM Code For Acute Tonsillitis: Group Overview

Sign up for ICD-10-CM Code For Acute Tonsillitis: Group Overview policy alerts

ICD-10-CM J03: Acute Tonsillitis Overview

When to Use

ICD-10-CM Codes

DRG Codes

Typical Clinical Scenarios

Related Codes

Which diagnoses are included in the ICD-10-CM J03 group?

How does J03 capture laterality or recurrence in coding?

What clinical features should documentation reflect for accurate J03 coding?

Which related DRGs might be relevant when J03 diagnoses appear on a claim?

What is the primary purpose of accurate coding within the ICD-10-CM J03 group?

References

When to Use

ICD-10-CM Codes

DRG Codes

Typical Clinical Scenarios

Related Codes

Which diagnoses are included in the ICD-10-CM J03 group?

How does J03 capture laterality or recurrence in coding?

What clinical features should documentation reflect for accurate J03 coding?

Which related DRGs might be relevant when J03 diagnoses appear on a claim?

What is the primary purpose of accurate coding within the ICD-10-CM J03 group?

References