ICD-10 Codes for Sore Throat

Are you assigning ICD-10-CM codes for a sore throat but don’t know where to start? This blog is a comprehensive guide for you to learn about all the codes associated with sore throat.

We will also be differentiating between sore throat and some relevant medical conditions so you don’t accidentally assign the wrong code. You can also find some key documentation guidelines that you can keep in mind while assigning these codes. 

Also, boost your revenue cycle with our expert coding solutions. We adhere to the latest ICD-10 standards for unmatched accuracy. Discover how we enhance coding precision.

List of ICD-10 Codes for Sore Throat

The primary code for sore throat is R07. It is associated with pain in the throat and chest as a non-billable code. There are five categories of the ICD 10 code R07. Let’s look at those categories in detail:

• ICD 10 Code R07.0

This code is associated with pain in the throat. It is a billable code and the ICD-9-CM code for this diagnosis is 784.1.

• ICD 10 Code R07.1

This code is associated with chest pain on breathing. It is a billable code and the ICD-9-CM code for this diagnosis is 786.52.

• ICD 10 Code R07.2

This code is associated with precordial pain. It is a billable code and the ICD-9-CM code for this diagnosis is 786.51.

• ICD 10 Code R07.8

This code is associated with other chest pains. It is non-billable as it has subtypes with more details about the diagnosis. Here is a closer look at those subtypes:

ICD-10 Code	Disease-Associated	ICD-9-CM Code	Billable/Non-Billable
R07.81	Pleurodynia	Billable	786.52
R07.82	Intercostal Pain	Billable	786.59
R07.89	Other Chest Pain	Billable	786.59

• ICD 10 Code R07.9

This code is associated with an unspecified chest pain. It is a billable code and can be used if none of the above codes can be applied to the relevant patient case. The ICD-9-CM code for this diagnosis is 786.50.

Differentiating Between Sore Throat and Other Conditions

You should identify the exact cause to diagnose a sore throat. That is how you will be able to give effective treatment and assign accurate ICD-10 codes. Various medical conditions can cause a sore throat.

They have different characteristics that enable you to distinguish them from one another. Let’s differentiate sore throat from common relevant medical conditions:

• Tonsillitis

Tonsillitis is a medical condition in which the tonsils get inflamed and often lead to a sore throat. It is commonly accompanied by symptoms like fever and difficulty in swallowing. The tonsils may appear red and swollen. They may also sometimes have white or yellow spots.

• Strep Throat

Strep throat is caused by a bacterial infection. It results in a severe sore throat along with a high fever and swollen lymph nodes in the neck. It does not typically cause a cough or runny nose as it is not a viral infection. Therefore, it is easier for you to identify.

• Common Cold

On the other hand, the common cold is a viral infection that causes a sore throat. There are other symptoms as well like a runny nose, coughing, and congestion. Its sore throat is usually milder compared to bacterial infections. It is also one of the first symptoms to appear.

• Influenza

Influenza is another viral infection that is more severe than the common cold. It also includes symptoms such as fever, body aches, fatigue, and an intense sore throat. Influenza can make the entire body feel unwell and not just the throat.

• Reflux Disease (GERD)

With GERD, the stomach acid backs up into the esophagus. This causes a burning sensation in the throat. Patients often mistake that sensation for a sore throat. It is a chronic sore throat which is typically worse in the morning. It can be accompanied by a sour taste in the mouth.

• Allergic Rhinitis

Allergies can also be misjudged as a lone sore throat. In case of allergies, mucus drops down from the nose to the throat. This is how it causes irritation in that area. This condition is often seasonal and accompanied by other allergy symptoms. Those symptoms usually include sneezing, itchy eyes, and a runny nose.

Documentation Guidelines for Sore Throat

We have combined all the documentation guidelines that can help you while assigning medical codes to sore throat cases. Let’s have a look at them:

• Symptom Details: Document the patient’s symptoms in detail. Include the onset, duration, and severity of the sore throat.
• Associated Symptoms: Record any related symptoms as well such as fever, cough, or difficulty swallowing. They can provide clues to the underlying cause.
• Medical History: Include relevant medical history as it could affect the diagnosis or treatment. There can be previous episodes of sore throat or related conditions.
• Physical Exam Findings: Note physical examination results of patients that include observations. Some examples of observations are redness, swelling, and pus in the throat.
• Diagnostic Tests: Document results from any diagnostic tests conducted. There can be a rapid strep test or throat culture conducted. Documenting them will confirm the diagnosis.
• Provider’s Assessment: Provide a detailed account of your medical assessment as well. It should especially include your thought process behind the diagnosis.
• Treatment Plan: Clearly outline your treatment plan for specific patients. It should specifically include prescribed medications and other interventions.
• Importance of Clarity: Ensure that your notes are clear and concise to support the assigned ICD-10 code. They enable effective communication with insurers.
• Avoiding Vague Documentation: Be thorough in your documentation to avoid vague or incomplete records. Such errors can cause coding errors and compliance issues.

The Bottom Line

This blog covered all the codes associated with sore throat. The primary code identified is R07 that can be applied to pain in the throat and chest. We also differentiated between sore throat and other relevant medical conditions.

Apart from that, the blog discussed key documentation guidelines for coding sore throat. Contact Health Quest Billing and get a chance to work with the most skilled medical billers in the healthcare market.