ICDcodes.org
FY2027

J03 vs J35.1

J03 and J35.1 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.

The official note, declared on J03
hypertrophy of tonsils (J35.1)
J03

Acute tonsillitis

Not billable
Chapter 10
Diseases of the respiratory system
Section
J00-J06
J35.1

Hypertrophy of tonsils

Billable
Chapter 10
Diseases of the respiratory system
Section
J30-J39
Use when the record says
  • Enlargement of tonsils
Indexed under
  • Enlargement, enlarged › tonsils
  • Hyperplasia, hyperplastic › tonsils
  • Hypertrophy, hypertrophic › lingual tonsil
  • Hypertrophy, hypertrophic › tonsils

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