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J35.1 ICD-10-CM Code: Hypertrophy of tonsils

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

Coding at a Glance

Tabular directives
1 inclusion term · 1 Excludes1

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 v44, 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 154 — OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC (MDC 03)
  • MS-DRG 155 — OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC (MDC 03)
  • MS-DRG 156 — OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/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 J35.1 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Enlargement of tonsils

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).

Coder workflow for J35.1

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

Before you code J35.1

  1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with J35.1. 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 J35.1’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.

    ReviewJ35.0

Consider J35.1. 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 J35.1(1 note)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with J35.1: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareJ35.0

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

Coding decision scenarios

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

Documentation: Both the condition J35.1 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).

ReviewJ35.0

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.

Don’t confuse J35.1 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of J35.1 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • J35.0— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of hypertrophy of tonsils with tonsillitis moves the case to J35.0; the two are not reported together unless documented as unrelated.

    Full comparison: J35.1 vs J35.0 →

  • J35.9— Specificity relationship (Review)

    Overlapping diagnoses in the same category.

    Overlapping codes in the same category — the documentation decides which is the more specific fit.

    What moves you there: A record that documents no more than “Chronic disease of tonsils and adenoids, unspecified” takes J35.9; specificity in the record moves it back here.

    Full comparison: J35.1 vs J35.9 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Code Overview

Hypertrophy of tonsils is a billable ICD-10-CM diagnosis code (J35.1).

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 (4)

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 J35.1 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 1 Excludes1 note: J03 — Acute tonsillitis.

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

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 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 6 MS-DRGs: DRG 011 (MDC PRE), DRG 012 (MDC PRE), DRG 013 (MDC PRE), DRG 154 (MDC 03), DRG 155 (MDC 03), DRG 156 (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):RSP004 — Acute and chronic tonsillitis (default).

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 category (Acute and chronic tonsillitis).

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, J35.01 — Chronic tonsillitis, J35.02 — Chronic adenoiditis, J35.03 — Chronic tonsillitis and adenoiditis, J35.2 — Hypertrophy of adenoids, J35.3 — Hypertrophy of tonsils with hypertrophy of adenoids, J35.8 — Other chronic diseases of tonsils and adenoids, J35.9 — Chronic disease of tonsils and adenoids, unspecified, J36 — Peritonsillar abscess

Same Index main term, other category

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

I38 — Endocarditis, valve unspecified (heart, valve), I42.2 — Other hypertrophic cardiomyopathy (myocardium, idiopathic), I51.7 — Cardiomegaly (cardiac), I77.3 — Arterial fibromuscular dysplasia (artery, fibromuscular), I77.89 — Other specified disorders of arteries and arterioles (artery), I87.8 — Other specified disorders of veins (vein), J31.0 — Chronic rhinitis (rhinitis), J33.9 — Nasal polyp, unspecified (nose, polypoid), J34.3 — Hypertrophy of nasal turbinates (nasal, turbinate), J34.89 — Other specified disorders of nose and nasal sinuses (nasal), J38.3 — Other diseases of vocal cords (vocal cord), J39.2 — Other diseases of pharynx (pharynx), J84.841 — Neuroendocrine cell hyperplasia of infancy (neuroendocrine cell, of infancy), K03.4 — Hypercementosis (cementation), K06.1 — Gingival enlargement (gum), K06.2 — Gingival and edentulous alveolar ridge lesions associated with trauma (denture), K08.89 — Other specified disorders of teeth and supporting structures (alveolar ridge), K11.1 — Hypertrophy of salivary gland (parotid gland), K13.0 — Diseases of lips (lip), K13.29 — Other disturbances of oral epithelium, including tongue (epithelial, tongue), +134 more

Contextual Map

Every relationship of J35.1 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 J35.1 with these 2 related codes in Claim Check

Hierarchy

Excludes1

Referenced by Excludes1 notes

  • J03 — Acute tonsillitis[Excludes1]: “hypertrophy of tonsils (J35.1)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

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. 175 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027
  • 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. 5,151 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027

Index entries

  • Enlargement, enlarged, tonsils[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Hyperplasia, hyperplastic, tonsils (faucial) (infective) (lingual) (lymphoid)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Hypertrophy, hypertrophic, lingual tonsil (infective)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Hypertrophy, hypertrophic, tonsils (faucial) (infective) (lingual) (lymphoid)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

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

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 FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 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 — v44 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. "J35.1 — Hypertrophy of tonsils." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/j35.1-hypertrophy-of-tonsils

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Hypertrophy of tonsils

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, 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 J35.1 in its code family, with their registry titles.

View all codes in the J35 family