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J03.9 ICD-10-CM Code: Acute tonsillitis, unspecified

Billing Status: NO. This is a clinician non-billable / parent hierarchy grouping in the ICD-10-CM system.

Coding at a Glance

Tabular directives
5 inclusion terms · 7 Excludes1 · 1 Excludes2

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for J03.9 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 J03.9 itself; “inherited from” names the category or block whose note applies here.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Follicular tonsillitis (acute)
  • Gangrenous tonsillitis (acute)
  • Infective tonsillitis (acute)
  • Tonsillitis (acute) NOS
  • Ulcerative tonsillitis (acute)

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.

Source: inherited from J03

Coder workflow for J03.9

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

Before you code J03.9

  1. J03.9 is not reportable as written. Select the more specific code beneath it that the documentation supports. Codes are reported to the highest level of specificity the classification provides (Guidelines I.B.2).

    ReviewJ03.90, J03.91

    See the relationships section · Guide: How to choose an ICD-10-CM code →

  2. Unspecified does not mean incorrect. When the record gives no greater specificity, J03.9 may be the appropriate code. Check the record for detail that supports a more specific sibling — in this subcategory the siblings differ by acute versus chronic. An unspecified code is for records that do not provide the detail a more specific code needs; a query, not an assumption, is the route to specificity (Guidelines I.A.9.b, I.B.18).

    ReviewJ03.0, J03.8

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

  3. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with J03.9. 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 one of the more specific codes beneath J03.9?
    Yes → Select that code and continue the checks below on its own page.
    No → J03.9 cannot be reported as written; query for the specificity its subcategory needs.

    ReviewJ03.90, J03.91

  2. Does the record document the detail a more specific sibling code needs?
    Yes → Review the specific siblings in this subcategory.
    No → Continue — J03.9 is appropriate when the documentation goes no further.

    ReviewJ03.0, J03.8

  3. Does the documentation support a condition named in J03.9’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.

    ReviewJ09.X2, J10.1, J11.1, J02, J35.1, J36

Consider J03.9. 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).
Any detail beyond this code’s title
What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes1 — check before selecting J03.9(7 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with J03.9: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareJ09.X2, J10.1, J11.1, J02, J35.1, J36

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

  • Excludes2 — not part of J03.9(1 note)

    Coding workflow: The conditions named in this note are not included in J03.9. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareJ35.0

    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: The provider documents the condition in the terms of this code’s title and records no further detail.

Coding question: Is a more specific sibling code supportable?

Path: Review the specific siblings in this subcategory and what each requires the record to state.

Reason: A more specific code needs documentation of the distinguishing element; without it the unspecified code is appropriate, and a provider query is the route to specificity (Guidelines I.A.9.b, I.B.18).

ReviewJ03.0, J03.8

Documentation: Both the condition J03.9 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).

ReviewJ09.X2, J10.1, J11.1, J02, J35.1, J36

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

Acute tonsillitis, unspecified is a non-billable ICD-10-CM category code (J03.9). A more specific billable subcode must be selected for claims submission.

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

Verify Before Coding

  • Not billable as written — a more specific code is required: J03.90, J03.91.

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 J03.9 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 2 Excludes1 notes: J36 — Peritonsillar abscess (via J03.-), J36 — Peritonsillar abscess.

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: J35.0 — Chronic tonsillitis and adenoiditis (via J03.-).

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 J03.-).

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

Contextual Map

Every relationship of J03.9 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 J03.9 with these 6 related codes in Claim Check

Hierarchy

Excludes1

Referenced by Excludes1 notes

Referenced by Excludes2 notes

Referenced by Code Also instructions

Nearest codes (9)

Change history

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

Common coding questions

Can J03.9 be billed directly?

No. J03.9 (Acute tonsillitis, unspecified) is a non-billable ICD-10-CM category code. A more specific billable subcode must be selected based on clinical documentation.

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
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. "J03.9 — Acute tonsillitis, unspecified." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/j03.9-acute-tonsillitis-unspecified

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Acute tonsillitis, unspecified

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 J03.9 in its code family, with their registry titles.

View all codes in the J03 family