J36
Billable codePeritonsillar abscess
The ICD-10 code for peritonsillar abscess is J36.
Clinical notes
Excludes1 (not coded here)
An Excludes1 note is a pure exclusion: the excluded condition and this code should never be reported together, because the two conditions cannot occur at the same time (e.g. a congenital form vs. an acquired form of the same disease).
Includes
Terms listed here further define or give examples of the conditions grouped under this code — they describe what the code covers, not a separate diagnosis.
- abscess of tonsil
- peritonsillar cellulitis
- quinsy
Documentation support
General coding-documentation guidance — not a substitute for payer-specific requirements or professional coding judgment.
- •Confirm the excluded condition(s) listed above are not also present — Excludes1 conditions cannot be coded together with this one.
- •If the associated manifestation or related condition noted above is also documented, an additional code should be reported alongside this one.
- •As a general rule, code to the highest level of specificity supported by the documentation in the medical record.
Related codes in this category
- J30Vasomotor and allergic rhinitisnon-billable header
- J31Chronic rhinitis, nasopharyngitis and pharyngitisnon-billable header
- J32Chronic sinusitisnon-billable header
- J33Nasal polypnon-billable header
- J34Other and unspecified disorders of nose and nasal sinusesnon-billable header
- J35Chronic diseases of tonsils and adenoidsnon-billable header
- J37Chronic laryngitis and laryngotracheitisnon-billable header
- J38Diseases of vocal cords and larynx, not elsewhere classifiednon-billable header
- J39Other diseases of upper respiratory tractnon-billable header
- J36Peritonsillar abscess
ICD-9-CM equivalent
Informational only — GEM mappings are approximate, not guaranteed one-to-one equivalents. Verify before use in billing.
- 475
Associated MS-DRGs
J36 can serve as the principal diagnosis for these Medicare Severity Diagnosis-Related Groups.
Informational only — actual DRG assignment also depends on procedures, complications/comorbidities (CC/MCC), discharge status, and payer-specific rules not reflected here.
- DRG 011Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with MCC
- DRG 012Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy with CC
- DRG 013Tracheostomy for Face, Mouth and Neck Diagnoses or Laryngectomy without CC/MCC
- DRG 152Otitis Media and URI with MCC
- DRG 153Otitis Media and URI without MCC