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R07.0
ICD-10-CM
Pain in Throat

Find information on throat pain diagnosis, including clinical documentation, medical coding, and healthcare guidance. Explore causes, symptoms, and treatment options for pharyngitis, tonsillitis, and other related conditions. Learn about ICD-10 codes for sore throat, throat pain, and relevant medical terminology used in healthcare settings. This resource provides valuable insights for healthcare professionals, medical coders, and individuals seeking information on throat pain diagnosis and management.

Also known as

Throat Pain
Pharyngeal Pain

Diagnosis Snapshot

Key Facts
  • Definition : Discomfort or pain in the throat area, often described as scratchy, burning, or raw.
  • Clinical Signs : Redness, swelling, difficulty swallowing, hoarseness, swollen tonsils or lymph nodes.
  • Common Settings : Viral or bacterial infections, allergies, acid reflux, voice strain, tonsillitis, pharyngitis.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC R07.0 Coding
R07.0

Pain in throat

Pain localized to the throat area.

J02-J06

Acute upper respiratory infections

Infections of the upper respiratory tract, often causing throat pain.

J35.0-J35.9

Chronic pharyngitis and nasopharyngitis

Long-term inflammation of the pharynx, which can cause throat pain.

R13

Dysphagia

Difficulty swallowing, sometimes accompanied by throat pain.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the throat pain related to a strep infection?

  • Yes

    Code J02.0 Streptococcal pharyngitis

  • No

    Is the pain due to acute tonsillitis?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Pain in throat
Acute pharyngitis
Chronic pharyngitis

Documentation Best Practices

Documentation Checklist
  • Document throat pain onset, duration, character.
  • Location specifics (tonsils, pharynx, etc.)
  • Associated symptoms (dysphagia, fever, etc.)
  • Aggravating and alleviating factors documented
  • Physical exam findings (erythema, exudates, etc.)

Mitigation Tips

Best Practices
  • Document throat pain location, duration, character for accurate ICD-10 coding.
  • Specify infectious vs non-infectious cause for proper CDI and HCC coding.
  • Review strep/flu test results in documentation to support medical necessity.
  • Ensure compliant billing by linking diagnosis to appropriate E/M code level.
  • Query physician for unclear throat pain etiology to improve coding accuracy.

Clinical Decision Support

Checklist
  • Verify symptom onset, duration, and character (ICD-10 J02.9, J31.2)
  • Assess associated symptoms: fever, cough, difficulty swallowing (R07.0, R05, R13.1)
  • Examine throat for redness, swelling, exudates (physical exam documentation)
  • Consider strep test if indicated (patient safety, appropriate testing)
  • Document diagnosis and treatment plan (accurate coding, quality measures)

Reimbursement and Quality Metrics

Impact Summary
  • Diagnosis: Pain in Throat (ICD-10 J02.9, J39.2)
  • Reimbursement: Accurate coding maximizes throat pain diagnosis reimbursement. Optimize medical billing for J02.9 or J39.2.
  • Quality Metrics: Throat pain diagnosis coding impacts quality reporting. Accurate ICD-10 coding (J02.9, J39.2) is crucial.
  • Impact 1: Correct coding ensures appropriate reimbursement for throat pain evaluation and management.
  • Impact 2: Accurate diagnosis coding improves hospital quality reporting for pharyngitis and throat pain related conditions.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes for . Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Code sore throat specificity (ICD-10 J02.X)
  • Document pain location, character, duration
  • R/O strep throat, pharyngitis, tonsillitis
  • Consider acute vs chronic pain codes
  • Link throat pain to underlying diagnosis if applicable

Documentation Templates

Patient presents with a primary complaint of throat pain (pharyngalgia, sore throat).  Onset of symptoms was [duration] ago and is characterized as [quality of pain: sharp, dull, burning, scratching, etc.].  Associated symptoms may include dysphagia (difficulty swallowing), odynophagia (painful swallowing), hoarseness, cough, fever, headache, myalgia, fatigue, rhinorrhea, or ear pain.  The patient denies [pertinent negatives: e.g., difficulty breathing, stridor, recent travel, known exposure to infectious diseases].  Physical examination reveals [objective findings: e.g., erythematous pharynx, tonsillar exudates, swollen lymph nodes, clear lungs].  Rapid strep test [positive/negative].  Differential diagnosis includes pharyngitis (viral, bacterial, or fungal), tonsillitis, postnasal drip, laryngitis, GERD, allergic rhinitis, mononucleosis, and peritonsillar abscess.  Assessment: Throat pain likely secondary to [most likely diagnosis].  Plan: [treatment plan: e.g., symptomatic treatment with analgesics, antipyretics, throat lozenges, salt water gargles; antibiotics if bacterial infection suspected; further evaluation if symptoms persist or worsen; patient education on hydration and rest].  Follow-up as needed.  ICD-10 code: [appropriate ICD-10 code, e.g., J02.9 for acute pharyngitis, unspecified].  CPT code: [appropriate CPT code for visit and procedures, e.g., 99213 for established patient office visit, level 3].
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