J36 — Peritonsillar abscess
J36 is a billable, specific ICD-10-CM code for peritonsillar abscess. It is valid for submission on a claim.
Excludes1 — never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
Use additional code
Add a secondary code to capture the detail described below.
Includes
Conditions this code covers.
- abscess of tonsil
- peritonsillar cellulitis
- quinsy
Other codes that can never be billed with J36
These codes carry an Excludes1 note pointing at J36. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading J36 alone.
Risk adjustment
J36 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
J36 is named in 1 Medicare coverage policy — 1 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A57204Billing and Coding: MRI and CT Scans of the Head and Neck
How J36 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to J36.
- Peritonsillitis
- Quinsy(gangrenous)
- Abscess›circumtonsillar
- Abscess›intratonsillar
- Abscess›peritonsillar
- Abscess›posttonsillar
- Abscess›tonsil(s) (lingual)
- Abscess›tonsillopharyngeal
- Angina›phlegmonous
- Angina›tonsil
- Cellulitis›peritonsillar
- Cellulitis›tonsil
Questions about J36
- Is J36 a billable ICD-10-CM code?
- Yes. J36 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does J36 sit in the tabular list?
- Diseases of the respiratory system (J00-J99), in the block Other diseases of upper respiratory tract (J30-J39).
- What cannot be coded together with J36?
- J36 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.