Provider Alert! Pharyngitis Testing Reminder

Date: August 17, 2023

Attention: Primary Care Providers

Call to action:

Pharyngitis (also known as sore throat) is a common, predominately viral, self-limiting condition which can be symptomatically managed without antibiotic treatment. Inappropriate antibiotic use for pharyngitis contributes to the development and spread of antibiotic resistance. Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7693205/

However, a small proportion of sore throats caused by group A streptococcal (GAS) infection may benefit from the provision of antibiotics. Establishing the cause of infection is an important step in effective antibiotic stewardship.

Why it matters:

Pharyngitis is a leading cause of outpatient care and can be due to a viral or bacterial infection. Viral pharyngitis does not respond to or require antibiotic treatment, but antibiotics continue to be inappropriately prescribed. Proper testing and treatment of pharyngitis prevents the spread of sickness, while reducing unnecessary use of antibiotics. The misuse of antibiotics can have adverse clinical outcomes such as Clostridium difficile (C. diff) infections and has public health implications, including encouragement of antibiotic resistance (when antibiotics can no longer cure bacterial infections). Antibiotic resistance is a major health concern in the United States, with 2.8 antibiotic-resistant infections and 35,000 deaths occurring annually. Source: https://www.ncqa.org/hedis/measures/appropriate-testing-for-pharyngitis/

How this impacts providers:

Providers should perform a strep test (rapid assay or throat culture) in order to determine whether antibiotic use is appropriate for patients with sore throat. Prescribing antibiotics, especially when no bacterial infection has been confirmed, can lead to side effects like diarrhea, vomiting, or yeast infections as well as the development of antibiotic resistance.  Appropriate testing helps keep patients healthy, which ultimately decreases overall healthcare costs. 

Member Education Guidance:

Patients often request an antibiotic to treat symptoms, even if they do not test positive for a bacterial infection.  Explain that antibiotics will not treat a viral infection and unnecessary use of antibiotics can build up antibiotic drug resistance in the patient.

Educate patients on how to treat their symptoms:

• Over-the-counter medications, such as nonsteroidal analgesics and or/acetaminophen
• Cool-mist vaporizers and nasal sprays for congestion
• Eating ice chips to soothe throat pain
• Throat spray or lozenges for older children and adults with sore throats
• Extra fluids and rest

Billing guidance:

Providers should direct TCHP members to an in network lab. To search for an in network lab click here: https://www.texaschildrenshealthplan.org/find-a-provider.

The CPT code for strep testing is 87880.

Diagnosis codes:

J02.0      Streptococcal pharyngitis

J02.8      Acute pharyngitis due to other specified organisms

J02.9      Acute pharyngitis, unspecified

J03.00    Acute streptococcal tonsillitis, unspecified

J03.01    Acute recurrent streptococcal tonsillitis

J03.80    Acute tonsillitis due to other specified organisms

J03.81    Acute recurrent tonsillitis due to other specified organisms

J03.90    Acute tonsillitis, unspecified

J03.91    Acute recurrent tonsillitis, unspecified

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.