J36

Billable

Peritonsillar abscess

This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).

What This Code Means

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.

Coding Tips

•Verify documentation specifies peritonsillar abscess rather than other throat infections like retropharyngeal abscess (J39.0) or epiglottitis (J05.10)
•Check if the abscess required drainage or aspiration, as this may be coded separately with a procedure code and could affect severity assessment

Includes

abscess of tonsil
peritonsillar cellulitis
quinsy

Excludes 1 — Do NOT code together

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

Use Additional Code

code (B95-B97) to identify infectious agent.

Code Hierarchy

└J36Peritonsillar abscess

J36