J02.9 vs J11.1
J02.9 and J11.1 can never be reported together. ICD-10-CM declares them mutually exclusive with an Excludes1 note, meaning the two conditions cannot occur in the same patient — so exactly one of them is correct for any given encounter.
J02.9
Acute pharyngitis, unspecified
BillableUnspecified
- Chapter 10
- Diseases of the respiratory system
- Section
- J00-J06
Use when the record says
- Gangrenous pharyngitis (acute)
- Infective pharyngitis (acute) NOS
- Pharyngitis (acute) NOS
- Sore throat (acute) NOS
- Suppurative pharyngitis (acute)
- Ulcerative pharyngitis (acute)
Indexed under
- Faucitis
- Pharyngitis (acute) (catarrhal)(gangrenous) (infective) (malignant) (membranous) (phlegmonous) (pseudomembranous) (simple) (subacute) (suppurative) (ulcerative)
- Necrosis, necrotic › pharynx (ischemic)
- Pharyngitis › purulent (acute) (catarrhal)(gangrenous) (infective) (malignant) (membranous) (phlegmonous) (pseudomembranous) (simple) (subacute) (suppurative) (ulcerative)
- Pharyngitis › putrid (acute) (catarrhal)(gangrenous) (infective) (malignant) (membranous) (phlegmonous) (pseudomembranous) (simple) (subacute) (suppurative) (ulcerative)
J11.1
Influenza due to unidentified influenza virus with other respiratory manifestations
Billable
- Chapter 10
- Diseases of the respiratory system
- Section
- J09-J18
Use when the record says
- Influenza NOS
- Influenzal laryngitis NOS
- Influenzal pharyngitis NOS
- Influenza with upper respiratory symptoms NOS
Indexed under
- Influenza (bronchial) (epidemic) (respiratory (upper)) (unidentified influenza virus)
- Influenza › with › laryngitis (bronchial) (epidemic) (respiratory (upper)) (unidentified influenza virus)
- Influenza › with › pharyngitis (bronchial) (epidemic) (respiratory (upper)) (unidentified influenza virus)
- Influenza › with › respiratory manifestations NEC (bronchial) (epidemic) (respiratory (upper)) (unidentified influenza virus)
Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027