J36
J36: Peritonsillar abscess
Billable / specific codeICD-10-CM
J36 is a billable, specific ICD-10-CM code for peritonsillar abscess. It is valid for submission on a claim.
Check J36 with the rest of the claim: free scrubberExcludes1: 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
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Medicare coverage
J36 is named in 1 Medicare coverage policy: 1 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A57204Billing and Coding: MRI and CT Scans of the Head and Neck
Alphabetic index entries that lead here
- 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
Code history
Unchanged in every release from FY2024 to FY2027.