FY2027
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Excludes1 pair

J02- vs J36

J02 and J36 are not coded together. ICD-10-CM declares them mutually exclusive with an Excludes1 note — the two conditions are not expected to occur together, so exactly one of them is normally correct for a given encounter. The Official Guidelines carve out one exception: if the two conditions are clearly unrelated to each other, both may be reported.

The official note, declared on J02
peritonsillar abscess (J36)
J02

Acute pharyngitis

Not billable
Chapter 10
Diseases of the respiratory system
Section
J00-J06
Use when the record says
  • acute sore throat
J36

Peritonsillar abscess

Billable
Chapter 10
Diseases of the respiratory system
Section
J30-J39
Use when the record says
  • abscess of tonsil
  • peritonsillar cellulitis
  • quinsy
Indexed under
  • Peritonsillitis
  • Quinsy (gangrenous)
  • Abscess › circumtonsillar
  • Abscess › intratonsillar
  • Abscess › peritonsillar

Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027