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J02.0

Billable

Streptococcal pharyngitis

This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).

What This Code Means

A sore throat infection caused by streptococcal bacteria, commonly known as strep throat. This is a contagious bacterial infection that causes pain, inflammation, and difficulty swallowing.

Coding Tips

  • Verify the documentation specifically identifies streptococcal bacteria (Group A Streptococcus is most common) rather than viral pharyngitis, as this distinction is critical for accurate coding
  • Do not use this code if the infection is caused by other organisms; confirm the causative agent is streptococcal before assigning J02.0

Excludes 2 — Not included here, may code separately

  • scarlet fever (A38.-)

Code Hierarchy

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