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ICD-10 Coding for Breast Abscess(N61.1, O91.13)

Complete ICD-10-CM coding and documentation guide for Breast Abscess. Includes clinical validation requirements, documentation requirements, and coding pitfalls.

Also known as:

Mammary AbscessLactational AbscessPuerperal Breast Abscess

Related ICD-10 Code Ranges

Complete code families applicable to Breast Abscess

N60-N64Primary Range

Disorders of breast

This range includes conditions related to breast disorders, including abscesses.

Infections of breast associated with childbirth

This range is relevant for abscesses associated with lactation and puerperium.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
N61.1Abscess of breast and nippleUse for breast abscesses not associated with pregnancy or lactation.
  • Ultrasound confirmation of abscess
  • Clinical documentation of non-lactational context
O91.13Abscess of breast associated with lactationUse for abscesses occurring during lactation or postpartum.
  • Documentation of lactation or postpartum status
  • Ultrasound or clinical confirmation of abscess

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

Essential facts and insights about Breast Abscess

The ICD-10 code for a non-puerperal breast abscess is N61.1, while O91.13 is used for lactational breast abscesses.

Primary ICD-10-CM Codes for breast abscess

Abscess of breast and nipple
Billable Code

Decision Criteria

clinical Criteria

  • Absence of lactational or puerperal context

Applicable To

  • Non-puerperal breast abscess

Excludes

  • Puerperal breast abscess (O91.1x)

Clinical Validation Requirements

  • Ultrasound confirmation of abscess
  • Clinical documentation of non-lactational context

Code-Specific Risks

  • Incorrectly coding lactational abscess as non-puerperal

Coding Notes

  • Ensure documentation specifies non-lactational context.

Ancillary Codes

Additional codes that should be used in conjunction with the main diagnosis codes when applicable.

Cellulitis of trunk

L03.3
Use to document associated cellulitis.

Encounter for care and examination of mother immediately after delivery

Z39.0x
Use to document postpartum care context.

Differential Codes

Alternative codes to consider when ruling out similar conditions to the primary diagnosis.

Abscess of breast associated with lactation

O91.13
Use when the abscess is related to breastfeeding or occurs postpartum.

Abscess of breast and nipple

N61.1
Use when the abscess is not related to lactation.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Breast Abscess to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N61.1.

Impact

Clinical: Misrepresentation of patient condition., Regulatory: Potential for audit discrepancies., Financial: Incorrect reimbursement due to coding errors.

Mitigation Strategy

Use structured templates for documentation., Verify lactation status during patient intake.

Impact

Reimbursement: May result in incorrect DRG assignment and reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.

Mitigation Strategy

Verify lactational context in documentation before coding.

Impact

High risk of incorrect coding due to omission of lactational context.

Mitigation Strategy

Implement regular audits and training on documentation requirements.

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 expert answers to help guide accurate code selection and documentation.

Documentation Templates for Breast Abscess

Use these documentation templates to ensure complete and accurate documentation for Breast Abscess. These templates include all required elements for proper coding and billing.

Breast Abscess in Lactating Patient

Specialty: Obstetrics and Gynecology

Required Elements

  • Patient history including lactation status
  • Physical examination findings
  • Ultrasound results
  • Procedure details if I&D performed

Example Documentation

Patient presents with a 3 cm fluctuant mass in the right breast, 4 weeks postpartum. Ultrasound confirms abscess. I&D performed with packing.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Breast abscess drained.
Good Documentation Example
3 cm fluctuant abscess at 2 o’clock right breast; purulent drainage (10 mL) cultured; lactational abscess in breastfeeding patient 4 weeks postpartum.
Explanation
The good example provides specific details on size, location, and lactational context, which are necessary for accurate coding.

Need help with ICD-10 coding for Breast Abscess? Ask your questions below.

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