ICD-10 Coding for Breast Abscess with Erythema Nodosum(O91.13, O91.12, L52)
Complete ICD-10-CM coding and documentation guide for Breast Abscess with Erythema Nodosum. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Breast Abscess with Erythema Nodosum
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| O91.13 | Abscess of breast associated with lactation | Use when the abscess occurs in a lactating patient up to 6 months postpartum. |
|
| O91.12 | Abscess of breast associated with the puerperium | Use when the abscess occurs in a non-lactating postpartum patient within 42 days. |
|
| L52 | Erythema nodosum | Use when erythema nodosum is present as a secondary condition. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for breast abscess with erythema nodosum
Essential facts and insights about Breast Abscess with Erythema Nodosum
Primary ICD-10-CM Codes for absceso erythema nodosum mama
Decision Criteria
clinical Criteria
- Patient is lactating and presents with breast abscess.
Applicable To
- Lactation-associated breast abscess
Excludes
- Non-lactation related breast abscess (N61.2)
Clinical Validation Requirements
- Ultrasound confirmation of abscess
- Documentation of lactation status
Code-Specific Risks
- Confusion with non-lactation related codes
Coding Notes
- Ensure lactation status is documented to avoid miscoding.
O91.12 - Abscess of breast associated with the puerperium
Use when the abscess occurs in a non-lactating postpartum patient within 42 days.
Applicable To
- Puerperal breast abscess
Excludes
- Non-puerperal breast abscess (N61.2)
Clinical Validation Requirements
- Ultrasound confirmation of abscess
- Documentation of puerperium status
Coding Notes
Ensure puerperium status is documented to avoid miscoding.
L52 - Erythema nodosum
Use when erythema nodosum is present as a secondary condition.
Applicable To
- Erythema nodosum as a reactive phenomenon
Excludes
- Other panniculitis (L98.3)
Clinical Validation Requirements
- Biopsy confirming erythema nodosum
- Documentation of concurrent conditions
Coding Notes
Ensure erythema nodosum is documented as secondary to another condition.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Breast Abscess with Erythema Nodosum to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code O91.13.
Impact
Clinical: Incomplete clinical picture., Regulatory: Non-compliance with coding standards., Financial: Potential underpayment for services.
Mitigation Strategy
Thorough skin examination documentation., Link skin findings to primary condition.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records and statistics.
Mitigation Strategy
Verify and document the patient's postpartum status clearly.
Impact
Improper sequencing of primary and secondary codes.
Mitigation Strategy
Regular training on ICD-10 coding guidelines.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Breast Abscess with Erythema Nodosum, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Breast Abscess with Erythema Nodosum
Use these documentation templates to ensure complete and accurate documentation for Breast Abscess with Erythema Nodosum. These templates include all required elements for proper coding and billing.
Lactating patient with breast abscess and erythema nodosum
Specialty: Obstetrics and GynecologyRequired Elements
- Lactation status
- Abscess confirmation
- Erythema nodosum linkage
- Microbiological findings
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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