Alphabetic Index FY2027

J36

Peritonsillar abscess

FY2027Chapter 10: Diseases of the respiratory system/J30–J39 Other diseases of upper respiratory tract

BillableComplete code, valid to report
Care settingsHome Health Primary · MMTA - OtherHospital CC

J36 is a billable ICD-10-CM diagnosis code for peritonsillar abscess. It is part of the FY2027 code set, effective October 1, 2026. The Alphabetic Index lists it under 16 entries. Its coding notes include a Use additional code instruction, 4 Excludes1 entries and 9 Excludes2 entries.

Use additional code

Add the listed code as a secondary code, if known.

This code
  • code (B95-B97) to identify infectious agent.
Also from chapter/block level (7 notes)
Inherited from Chapter 10 Diseases of the respiratory system
  • code, where applicable, to identify:
    • exposure to environmental tobacco smoke (Z77.22)
    • exposure to tobacco smoke in the perinatal period (P96.81)
    • history of tobacco dependence (Z87.891)
    • occupational exposure to environmental tobacco smoke (Z57.31)
    • tobacco dependence (F17.-)
    • tobacco use (Z72.0)

Excludes1

Not coded here. The listed conditions generally should not be reported together.

This code
  • acute tonsillitis (J03.-)
  • chronic tonsillitis (J35.0)
  • retropharyngeal abscess (J39.0)
  • tonsillitis NOS (J03.9-)

Excludes2

Not included here. Both codes may be reported if the patient has both conditions.

Also from chapter/block level (9 notes)
Inherited from Chapter 10 Diseases of the respiratory system
  • certain conditions originating in the perinatal period (P04-P96)
  • certain infectious and parasitic diseases (A00-B99)
  • complications of pregnancy, childbirth and the puerperium (O00-O9A)
  • congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
  • endocrine, nutritional and metabolic diseases (E00-E88)
  • injury, poisoning and certain other consequences of external causes (S00-T88)
  • neoplasms (C00-D49)
  • smoke inhalation (T59.81-)
  • symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)

Care settings

How CMS programs treat this code. These are CMS claim edits and list entries, not coverage or eligibility rules.

Home Health Primary

Accepted as the primary (principal) diagnosis on a home health claim. The Home Health Grouper assigns it to the MMTA - Other clinical group.

Source: CMS Home Health Grouper Software v07.2.26, effective October 1, 2026

Hospital CC

Counts as a complication or comorbidity (CC) when reported as a secondary diagnosis on an inpatient claim. It does not count when the principal diagnosis is one of the 9 codes in its exclusion list. Some MS-DRGs also ignore a CC or MCC that defines the DRG.

Source: CMS MS-DRG Definitions Manual v44, effective October 1, 2026, Appendix C

Includes

Further defines or gives examples of the content of the category.

This code
  • abscess of tonsil
  • peritonsillar cellulitis
  • quinsy

Notes

Also from chapter/block level (1 note)
Inherited from Chapter 10 Diseases of the respiratory system
  • When a respiratory condition is described as occurring in more than one site and is not specifically indexed, it should be classified to the lower anatomic site (e.g. tracheobronchitis to bronchitis in J40).

Alphabetic Index terms

Terms the official Alphabetic Index lists for this code. 16 entries

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