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J02.0 ICD-10-CM Code: Streptococcal pharyngitis

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
3 inclusion terms · 5 Excludes1 · 2 Excludes2

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 011 — TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC (MDC PRE)
  • MS-DRG 012 — TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC (MDC PRE)
  • MS-DRG 013 — TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC (MDC PRE)
  • MS-DRG 152 — OTITIS MEDIA AND URI WITH MCC (MDC 03)
  • MS-DRG 153 — OTITIS MEDIA AND URI WITHOUT MCC (MDC 03)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for J02.0 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on J02.0 itself; “inherited from” names the category or block whose note applies here.

Includes

Conditions the official ICD-10-CM tabular list includes under this code.

  • acute sore throat

Source: inherited from J02

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Septic pharyngitis
  • Streptococcal sore throat

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Coder workflow for J02.0

MedCoder structured workflow — derived from this code’s own official record

Before you code J02.0

  1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with J02.0. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in J02.0’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewJ06.0, J36, J39.1, J39.0, J44.0

Consider J02.0. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Acuity
Acute or chronic as documented; when both are documented and separate codes exist, both are reported with the acute code first (Guidelines I.B.8).

Official instructions as workflow

  • Excludes1 — check before selecting J02.0(5 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with J02.0: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareJ06.0, J36, J39.1, J39.0, J44.0

    See the official tabular notes · Guidelines I.A.12.a

  • Excludes2 — not part of J02.0(2 notes)

    Coding workflow: The conditions named in this note are not included in J02.0. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareA38, J31.2

    See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition J02.0 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewJ06.0, J36, J39.1, J39.0, J44.0

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Streptococcal pharyngitis is a billable ICD-10-CM diagnosis code (J02.0).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (8)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name J02.0 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 4 Excludes1 notes: J00 — Acute nasopharyngitis [common cold] (via J02.-), J03 — Acute tonsillitis (via J02.-), J03 — Acute tonsillitis, J06 — Acute upper respiratory infections of multiple and unspecified sites.

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 1 Excludes2 note: A38 — Scarlet fever.

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 1 Code Also instruction: D81.82 — Activated Phosphoinositide 3-kinase Delta Syndrome [APDS] (via J02.-).

These codes suggest coding this condition alongside when both are present.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 5 MS-DRGs: DRG 011 (MDC PRE), DRG 012 (MDC PRE), DRG 013 (MDC PRE), DRG 152 (MDC 03), DRG 153 (MDC 03).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):RSP006 — Other specified upper respiratory infections (default); INF003 — Bacterial infections.

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Other specified upper respiratory infections, Bacterial infections).

A36.0 — Pharyngeal diphtheria, A36.1 — Nasopharyngeal diphtheria, A36.2 — Laryngeal diphtheria, A50.03 — Early congenital syphilitic pharyngitis, A52.73 — Symptomatic late syphilis of other respiratory organs, A54.5 — Gonococcal pharyngitis, A56.4 — Chlamydial infection of pharynx, B00.2 — Herpesviral gingivostomatitis and pharyngotonsillitis, B08.5 — Enteroviral vesicular pharyngitis, J00 — Acute nasopharyngitis [common cold], J02.8 — Acute pharyngitis due to other specified organisms, J02.9 — Acute pharyngitis, unspecified, J04.0 — Acute laryngitis, J04.10 — Acute tracheitis without obstruction, J04.11 — Acute tracheitis with obstruction, J04.2 — Acute laryngotracheitis, J04.30 — Supraglottitis, unspecified, without obstruction, J04.31 — Supraglottitis, unspecified, with obstruction, J05.0 — Acute obstructive laryngitis [croup], J05.10 — Acute epiglottitis without obstruction, +402 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Pharyngitis”, “Septic”, “Sore”; these codes share that main term but sit in a different category of the Tabular List.

A50.03 — Early congenital syphilitic pharyngitis (syphilitic, congenital), A54.5 — Gonococcal pharyngitis (gonococcal), A56.4 — Chlamydial infection of pharynx (chlamydial), A57 — Chancroid (soft), A69.1 — Other Vincent's infections (fusospirochetal), B00.2 — Herpesviral gingivostomatitis and pharyngotonsillitis (herpesviral), B08.5 — Enteroviral vesicular pharyngitis (aphthous), B08.8 — Other specified viral infections characterized by skin and mucous membrane lesions (lymphonodular, acute), B55.1 — Cutaneous leishmaniasis (Delhi), D73.89 — Other diseases of spleen (spleen), H57.1 — Ocular pain (eye), J31.2 — Chronic pharyngitis (sicca), J35.01 — Chronic tonsillitis (tonsils, chronic), J35.03 — Chronic tonsillitis and adenoiditis (tonsils, chronic, with adenoiditis), K04.4 — Acute apical periodontitis of pulpal origin (teeth, tooth), K12.0 — Recurrent oral aphthae (mouth, canker), K13.79 — Other lesions of oral mucosa (mouth), K81.0 — Acute cholecystitis (gallbladder), L98.9 — Disorder of the skin and subcutaneous tissue, unspecified (skin), M79.10 — Myalgia, unspecified site (muscle), +2 more

Contextual Map

Every relationship of J02.0 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run J02.0 with these 5 related codes in Claim Check

Hierarchy

Excludes2

  • A38 — Scarlet fever[Excludes2]: “scarlet fever (A38.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Referenced by Excludes1 notes

Referenced by Excludes2 notes

  • A38 — Scarlet fever[Excludes2]: “streptococcal sore throat (J02.0)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Referenced by Code Also instructions

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • Pre-MDC[MDC crossing]: “Pre-MDC — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 153 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026
  • MDC 03 — Diseases and Disorders of the Ear, Nose, Mouth and Throat[MDC crossing]: “Diseases and Disorders of the Ear, Nose, Mouth and Throat — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 5,147 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Disease, diseased, throat, septic[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Pharyngitis (acute) (catarrhal)(gangrenous) (infective) (malignant) (membranous) (phlegmonous) (pseudomembranous) (simple) (subacute) (suppurative) (ulcerative), septic[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Pharyngitis (acute) (catarrhal)(gangrenous) (infective) (malignant) (membranous) (phlegmonous) (pseudomembranous) (simple) (subacute) (suppurative) (ulcerative), streptococcal[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Septic, sore, throat[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Septic, sore, throat, streptococcal[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Sore, throat (acute), septic[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Sore, throat (acute), streptococcal (ulcerative)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Ulcer, ulcerated, ulcerating, ulceration, ulcerative, sore throat, streptococcal[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "J02.0 — Streptococcal pharyngitis." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/j02.0-streptococcal-pharyngitis

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Streptococcal pharyngitis

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to J02.0 in its code family, with their registry titles.

View all codes in the J02 family