FY2027
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Excludes1 pair

J36 vs J39.0

J36 and J39.0 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
retropharyngeal abscess (J39.0)
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
J39.0

Retropharyngeal and parapharyngeal abscess

Billable
Chapter 10
Diseases of the respiratory system
Section
J30-J39
Use when the record says
  • Peripharyngeal abscess
Indexed under
  • Abscess › parapharyngeal
  • Abscess › peripharyngeal
  • Abscess › postpharyngeal
  • Abscess › retropharyngeal

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