J03
Non-Billable (Header)Acute tonsillitis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
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 but the actual diagnosis must be coded to the highest level of specificity supported by the documentation. Coders should look at J03's child codes and select the one that matches the patient's documented presentation, since payers reject header codes submitted as the primary diagnosis. For risk adjustment workflows, header codes never contribute to a Medicare Advantage member's RAF score on their own; only billable child codes that happen to map to a payment HCC affect risk-adjusted plan payments.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, 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
Excludes 2 — Not included here, may code separately
- chronic tonsillitis (J35.0)