J36 ICD-10-CM Code: Peritonsillar abscess
J36 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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FY 2026 Apr update / Diseases of the respiratory system (J00-J99) / Other diseases of upper respiratory tract (J30-J39)
J36
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePeritonsillar abscess
A peritonsillar abscess is a collection of pus that forms in the tissue around the tonsils, usually as a complication of strep throat or tonsillitis. It causes severe throat pain, difficulty swallowing, and may require drainage or antibiotics to treat.
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
OfficialNo inclusion terms are included in this display for J36. Check the code and parent instructions in the Code Book.
Excludes 2
Official- certain conditions originating in the perinatal period (P04-P96)Inherited from J00-J99
- certain infectious and parasitic diseases (A00-B99)Inherited from J00-J99
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from J00-J99
- congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)Inherited from J00-J99
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from J00-J99
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from J00-J99
- neoplasms (C00-D49)Inherited from J00-J99
- smoke inhalation (T59.81-)Inherited from J00-J99
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from J00-J99
Related Codes
No related codes are included in this display for J36. Check the Code Book for the complete code path.
Includes
Official- abscess of tonsil
- peritonsillar cellulitis
- quinsy
Excludes 1
Official- acute tonsillitis (J03.-)
- chronic tonsillitis (J35.0)
- retropharyngeal abscess (J39.0)
- tonsillitis NOS (J03.9-)
Code First
OfficialNo Code First sequencing instructions are included in this display for J36. Check the code and parent instructions in the Code Book.
Use Additional
Official- code (B95-B97) to identify infectious agent.
- code, where applicable, to identify:Inherited from J00-J99
- exposure to environmental tobacco smoke (Z77.22)Inherited from J00-J99
- exposure to tobacco smoke in the perinatal period (P96.81)Inherited from J00-J99
- history of tobacco dependence (Z87.891)Inherited from J00-J99
- occupational exposure to environmental tobacco smoke (Z57.31)Inherited from J00-J99
- tobacco dependence (F17.-)Inherited from J00-J99
- tobacco use (Z72.0)Inherited from J00-J99
Code Also
OfficialNo Code Also instructions are included in this display for J36. Check the code and parent instructions in the Code Book.
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 J36 an HCC code?
No. J36 is a billable ICD-10-CM code with no mapping under the current CMS-HCC V28 community payment model, and none under the ESRD, Part D RxHCC, or HHS-HCC models.
- Code
- J36
- Description
- Peritonsillar abscess
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
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What This Code Means
J36 is the ICD-10-CM diagnosis code for peritonsillar abscess. A peritonsillar abscess is a collection of pus that forms in the tissue around the tonsils, usually as a complication of strep throat or tonsillitis. It causes severe throat pain, difficulty swallowing, and may require drainage or antibiotics to treat. J36 sits in the ICD-10-CM chapter for diseases of the respiratory system (j00-j99), within the section covering other diseases of upper respiratory tract (j30-j39).
J36 is a billable ICD-10-CM code, but no current CMS-HCC V28 community payment mapping is shown, 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 peritonsillar abscess rather than other throat infections like retropharyngeal abscess (J39.0) or epiglottitis (J05.10).
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for J36 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Includes
- abscess of tonsil
- peritonsillar cellulitis
- quinsy