A36.1 ICD-10-CM Code: Nasopharyngeal diphtheria
A36.1 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC coding software
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Certain infectious and parasitic diseases (A00-B99) / Other bacterial diseases (A30-A49)
A36.1
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceNasopharyngeal diphtheria
Diphtheria is a serious bacterial infection that affects the nose and throat area, causing inflammation and a thick membrane to form that can block breathing. This specific type occurs when the infection is localized to the nasopharynx (the upper part of the throat behind the nose).
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for A36.1 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for A36.1 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for A36.1 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for A36.1 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for A36.1 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for A36.1 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for A36.1 in this effective period.
Buddy Documentation Tip
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is A36.1 an HCC code?
No. A36.1 is a billable ICD-10-CM code with no mapping under the CMS-HCC V28 or V24 community payment models, and none under the ESRD, Part D RxHCC, or HHS-HCC models.
- Code
- A36.1
- Description
- Nasopharyngeal diphtheria
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
Get the V28 mapping + MEAT cheat sheet
One printable reference: check representative V28 mappings and the documentation reminders your note needs. Free, no card.
Free PDF. No card. Unsubscribe anytime.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
A36.1 is the ICD-10-CM diagnosis code for nasopharyngeal diphtheria. Diphtheria is a serious bacterial infection that affects the nose and throat area, causing inflammation and a thick membrane to form that can block breathing. This specific type occurs when the infection is localized to the nasopharynx (the upper part of the throat behind the nose). A36.1 sits in the ICD-10-CM chapter for certain infectious and parasitic diseases (a00-b99), within the section covering other bacterial diseases (a30-a49).
A36.1 is a billable ICD-10-CM code, but the current payload does not show a mapping under the CMS-HCC V28 or V24 community payment models, and none under the ESRD, Part D RxHCC, or HHS-HCC models. Do not assign risk adjustment value from this page when no source-backed mapping is shown; verify the applicable model and payment year.
Verify documentation specifies nasopharyngeal involvement rather than other diphtheria sites (respiratory, cutaneous, or unspecified) as each has a different code.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for A36.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation specifies nasopharyngeal involvement rather than other diphtheria sites (respiratory, cutaneous, or unspecified) as each has a different code
- •Diphtheria is a reportable disease in most jurisdictions; ensure proper public health reporting is completed alongside coding