ICD-10 Coding for Possible Strep Pharyngitis with Negative Rapid Strep Test
Use ICD-10 code J02.9 (Acute pharyngitis, unspecified) for a patient with possible strep pharyngitis but a negative rapid strep test.
Primary Coding Approach
J02.9 (Acute pharyngitis, unspecified) is the appropriate code when strep pharyngitis is suspected but the rapid strep test is negative, as you cannot code for a confirmed streptococcal infection without laboratory confirmation 1.
Do not use J02.0 (Streptococcal pharyngitis) when the rapid strep test is negative, as this code requires confirmed group A streptococcal infection 1.
Age-Specific Diagnostic Considerations That May Affect Coding
In children and adolescents (ages 3-18), a negative RADT should be confirmed with a throat culture before finalizing the diagnosis, as rapid tests have 80-90% sensitivity and miss 10-20% of true strep infections 2, 3.
If the backup throat culture subsequently returns positive, you would then change the diagnosis code to J02.0 (Streptococcal pharyngitis) and initiate antibiotics—treatment within 9 days of symptom onset still prevents acute rheumatic fever 1, 2.
In adults, a negative RADT is sufficient to rule out streptococcal pharyngitis without backup culture confirmation, as adults have only 5-10% prevalence of group A streptococcal pharyngitis and extremely low risk of rheumatic fever 1, 4.
Clinical Management Implications for Coding
Withhold antibiotics when the rapid strep test is negative in adults, as the negative result effectively rules out group A streptococcal pharyngitis and treatment should be limited to symptomatic care only 1.
The high specificity of RADT (≥95%) means false positives are rare, but the 80-90% sensitivity means false negatives can occur, particularly in children 5, 2.
Code based on what you can confirm, not what you suspect—clinical symptoms alone cannot reliably differentiate strep from viral pharyngitis, with confirmed cases occurring only 35-50% of the time based on clinical grounds alone 2.
Common Coding Pitfalls to Avoid
Do not code J02.0 (Streptococcal pharyngitis) based on clinical suspicion alone without laboratory confirmation, as this leads to inappropriate antibiotic prescribing—up to 70% of patients with sore throats receive unnecessary antibiotics while only 20-30% actually have strep 1.
Avoid the temptation to code for "rule out strep" or "suspected strep"—instead, code the confirmed finding of acute pharyngitis (J02.9) 1.
Be aware that other organisms like group C streptococcus can cause severe pharyngitis with negative rapid strep tests, but these would still be coded as J02.9 unless specifically cultured and identified 6.
Documentation Requirements
Document the negative rapid strep test result in the medical record to support the use of J02.9 rather than J02.0 1.
For pediatric patients, document whether a backup throat culture was sent and note that antibiotics are being withheld pending culture results 2.
If clinical features strongly suggest viral etiology (cough, rhinorrhea, conjunctivitis, coryza), document these to support the decision for symptomatic treatment only 1, 5.