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:
Related ICD-10 Code Ranges
Complete code families applicable to Breast Abscess
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| N61.1 | Abscess of breast and nipple | Use for breast abscesses not associated with pregnancy or lactation. |
|
| O91.13 | Abscess of breast associated with lactation | Use for abscesses occurring during lactation or postpartum. |
|
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
Primary ICD-10-CM Codes for breast abscess
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.
O91.13 - Abscess of breast associated with lactation
Use for abscesses occurring during lactation or postpartum.
Applicable To
- Lactational breast abscess
Excludes
- Non-puerperal breast abscess (N61.1)
Clinical Validation Requirements
- Documentation of lactation or postpartum status
- Ultrasound or clinical confirmation of abscess
Coding Notes
Ensure lactational context is clearly documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
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 GynecologyRequired Elements
- Patient history including lactation status
- Physical examination findings
- Ultrasound results
- Procedure details if I&D performed
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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