FY2027
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Excludes1 pair

J35.0- vs J36

J35.0 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 J36
chronic tonsillitis (J35.0)
J35.0

Chronic tonsillitis and adenoiditis

Not billable
Chapter 10
Diseases of the respiratory system
Section
J30-J39
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