2025 ICD-10-CM code J36
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Diseases of the respiratory system - Other diseases of upper respiratory tract (J30-J39) Diseases of the respiratory system (J00-J99) Feed
Peritonsillar abscess; an accumulation of pus near the tonsils.
Modifiers may be applicable depending on the circumstances of the procedure.Consult your local payer guidelines for specifics.
Medical necessity for treatment of a peritonsillar abscess is established by the presence of symptoms and signs consistent with the diagnosis, such as severe sore throat, difficulty swallowing, fever, and trismus.Imaging studies may be necessary to confirm the diagnosis and rule out other conditions.Incision and drainage is medically necessary to relieve symptoms and prevent complications like airway compromise or sepsis.
Diagnosis and treatment of the peritonsillar abscess by an otolaryngologist or other qualified physician. This may involve physical examination, diagnostic testing, incision and drainage, antibiotic prescription, and monitoring of the patient's condition.
In simple words: A peritonsillar abscess is a pocket of pus that forms near the tonsils in the back of your throat.It's caused by an infection that spreads from the tonsils to the nearby tissues.You might feel pain when you swallow.
J36, Peritonsillar abscess, refers to a collection of purulent material in the area between the palatine tonsil and its capsule.This condition is characterized by inflammation spreading from the tonsils to the surrounding tissue, resulting in pus accumulation.The patient may experience pain while swallowing.Use additional code (B95-B97) to specify the infectious agent if known.Excludes acute tonsillitis (J03.-), chronic tonsillitis (J35.0), retropharyngeal abscess (J39.0), and tonsillitis not otherwise specified (J03.9-).
Example 1: A 30-year-old patient presents with severe sore throat, difficulty swallowing, and fever.Physical examination reveals a swollen and tender area near the tonsil.A diagnosis of peritonsillar abscess is made, and the patient undergoes incision and drainage of the abscess, followed by a course of antibiotics., A 15-year-old patient complains of a progressively worsening sore throat and difficulty swallowing for several days.Examination reveals a unilateral peritonsillar swelling with erythema.A CT scan confirms the presence of a peritonsillar abscess.The patient receives intravenous antibiotics and undergoes incision and drainage under general anesthesia., A 45-year-old patient with a history of recurrent tonsillitis experiences a sudden onset of severe throat pain, odynophagia, and trismus (jaw stiffness).Physical examination and imaging reveal a peritonsillar abscess.The patient is hospitalized for intravenous antibiotic therapy and close monitoring.
Complete history and physical examination documenting the symptoms (sore throat, difficulty swallowing, fever, etc.), findings on physical examination (tonsillar swelling, erythema, fluctuance), imaging studies (CT scan, ultrasound) confirming the diagnosis, details of the procedure (incision and drainage), and the prescribed treatment (antibiotics).
** This code should only be used when a peritonsillar abscess is definitively diagnosed.Always refer to the latest ICD-10-CM coding guidelines for the most up-to-date information and any updates or changes to the code.
- Payment Status: Active
- Specialties:Otolaryngology, Infectious Disease
- Place of Service:Office, Hospital Inpatient, Hospital Outpatient, Emergency Room - Hospital, Ambulatory Surgical Center