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J03 ICD-10-CM Code: Acute tonsillitis

J03 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC Buddy coding tools

ICD-10-CM Code View

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Code lookupJ03

FY 2026 Apr update / Diseases of the respiratory system (J00-J99) / Acute upper respiratory infections (J00-J06)

J03

Header CodeICD-10-CMOfficial ICD-10-CMCodebook guidance

Acute tonsillitis

OverviewRisk ModelsCode BookDocumentationAuditNotesEdition comparison

CMS-HCC V28

N/A

—

Not mapped

CMS-HCC V24

N/A

—

Not mapped

ACA/HHS

N/A

—

Not mapped

ESRD/PACE

N/A

—

Not mapped

RXHCC

N/A

—

Not mapped

Code Book Path

Official
J0Acute upper respiratory infections (J00-J06)J03Acute tonsillitis

Inclusion Terms

Official

No inclusion terms are included in this display for J03. Check the code and parent instructions in the Code Book.

Excludes 2

Official
  • chronic tonsillitis (J35.0)
  • certain conditions originating in the perinatal period (P04-P96)Inherited from J00-J99
  • certain infectious and parasitic diseases (A00-B99)Inherited from J00-J99
  • complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from J00-J99
  • congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from J00-J99
  • endocrine, nutritional and metabolic diseases (E00-E88)Inherited from J00-J99
  • injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from J00-J99
  • neoplasms (C00-D49)Inherited from J00-J99
  • smoke inhalation (T59.81-)Inherited from J00-J99
  • symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from J00-J99

Related Codes

Official
J03.0Streptococcal tonsillitisJ03.8Acute tonsillitis due to other specified organismsJ03.9Acute tonsillitis, unspecified

Includes

Official

No Includes notes are included in this display for J03. Check the code and parent instructions in the Code Book.

Excludes 1

Official
  • acute sore throat (J02.-)
  • hypertrophy of tonsils (J35.1)
  • peritonsillar abscess (J36)
  • sore throat NOS (J02.9)
  • streptococcal sore throat (J02.0)
  • chronic obstructive pulmonary disease with acute lower respiratory infection (J44.0)Inherited from J00-J06

Code First

Official

No Code First sequencing instructions are included in this display for J03. Check the code and parent instructions in the Code Book.

Use Additional

Official
  • code, where applicable, to identify:Inherited from J00-J99
  • exposure to environmental tobacco smoke (Z77.22)Inherited from J00-J99
  • exposure to tobacco smoke in the perinatal period (P96.81)Inherited from J00-J99
  • history of tobacco dependence (Z87.891)Inherited from J00-J99
  • occupational exposure to environmental tobacco smoke (Z57.31)Inherited from J00-J99
  • tobacco dependence (F17.-)Inherited from J00-J99
  • tobacco use (Z72.0)Inherited from J00-J99

Code Also

Official

No Code Also instructions are included in this display for J03. Check the code and parent instructions in the Code Book.

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Code
J03
Description
Acute tonsillitis
HCC (V28)
No CMS-HCC V28 mapping
RAF reference coefficient
—
Billable
No
Payment year
2026

Coder workflow notes

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What This Code Means

J03 is the ICD-10-CM diagnosis code for acute tonsillitis. J03 sits in the ICD-10-CM chapter for diseases of the respiratory system (j00-j99), within the section covering acute upper respiratory infections (j00-j06).

Header codes like J03 cannot be reported on claims directly; they organize child codes that share clinical context. Coders should select the billable child code that matches the documented presentation and then verify its current source-backed HCC mapping. Do not infer a child code or risk adjustment value from the header alone.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for J03 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Excludes 1, Do NOT code together

  • acute sore throat (J02.-)
  • hypertrophy of tonsils (J35.1)
  • peritonsillar abscess (J36)
  • sore throat NOS (J02.9)
  • streptococcal sore throat (J02.0)

Excludes 2, Not included here, may code separately

  • chronic tonsillitis (J35.0)

Child Codes

J03.0Streptococcal tonsillitis
J03.8Acute tonsillitis due to other specified organisms
J03.9Acute tonsillitis, unspecified

Code Hierarchy

└J03Acute tonsillitis
└J03Acute tonsillitis

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