ICD-10 code for tonsil ulcer

The ICD-10-CM code for tonsil ulcer is J35.8 (Other chronic diseases of tonsils and adenoids). The official index lists 1 more specific code, so check the documentation for details such as type, cause, site or severity before settling on J35.8.

Within J35, choose J35.8 (Other chronic diseases of tonsils and adenoids) only when documentation doesn't support a more specific option: chronic tonsillitis and adenoiditis (J35.0), hypertrophy of tonsils (J35.1), hypertrophy of adenoids (J35.2), hypertrophy of tonsils with hypertrophy of adenoids (J35.3) and chronic disease of tonsils and adenoids, unspecified (J35.9).

It is not a CC or MCC, so as a secondary diagnosis it doesn't change the MS-DRG severity level.

In MS-DRG v44.0, it is part of the grouping logic for DRG 011 (Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with MCC, relative weight 5.6154), DRG 012 (Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with CC, relative weight 4.381), DRG 013 (Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy without CC/MCC, relative weight 2.7307), DRG 154 (Other Ear, Nose, Mouth and Throat Diagnoses with MCC, relative weight 1.5921), DRG 155 (Other Ear, Nose, Mouth and Throat Diagnoses with CC, relative weight 0.9322) and DRG 156 (Other Ear, Nose, Mouth and Throat Diagnoses without CC/MCC, relative weight 0.6659), in Pre-MDC and MDC 03 (Diseases and Disorders of the Ear, Nose, Mouth and Throat), as a principal or secondary diagnosis. The DRG a claim lands in depends on the principal diagnosis, procedures and any CC/MCC secondary diagnoses.