ICD-10 Coding for Left Breast Abscess(N61.1, N61.22)
Complete ICD-10-CM coding and documentation guide for Left Breast Abscess. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Left Breast Abscess
N61.0-N61.9Primary Range
Disorders of the breast
This range includes codes for various breast disorders, including abscesses and mastitis.
Bacterial and viral infectious agents
These codes are used to identify the infectious organism causing the 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 the breast and nipple | Use for non-granulomatous abscesses of the breast where laterality is not specified. |
|
| N61.22 | Granulomatous mastitis, left breast | Use when granulomatous mastitis is confirmed by histology. |
|
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 left breast abscess
Essential facts and insights about Left Breast Abscess
Primary ICD-10-CM Codes for left breast abscess
Decision Criteria
clinical Criteria
- Presence of purulent drainage and positive bacterial culture.
documentation Criteria
- Absence of granulomatous inflammation in histology.
Applicable To
- Non-granulomatous breast abscess
Excludes
- Granulomatous mastitis (N61.2-)
Clinical Validation Requirements
- Ultrasound confirmation of abscess
- Positive culture for bacterial infection
Code-Specific Risks
- Does not specify laterality, which may affect documentation clarity.
Coding Notes
- Ensure documentation specifies whether the abscess is granulomatous to avoid incorrect coding.
N61.22 - Granulomatous mastitis, left breast
Use when granulomatous mastitis is confirmed by histology.
Applicable To
- Granulomatous inflammation with abscess
Excludes
- Non-granulomatous abscess (N61.1)
Clinical Validation Requirements
- Biopsy showing granulomatous inflammation
- Negative bacterial cultures
Coding Notes
Ensure histological confirmation of granulomas before using this code.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Staphylococcus aureus as the cause of diseases classified elsewhere
B95.6Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Left 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: May lead to inappropriate antibiotic therapy., Regulatory: Non-compliance with coding guidelines., Financial: Potential for denied claims due to incomplete coding.
Mitigation Strategy
Ensure culture results are documented in the patient's record., Use additional codes for organism identification.
Impact
Reimbursement: Incorrect coding may lead to denied claims or incorrect DRG assignment., Compliance: Non-compliance with coding guidelines due to lack of histological evidence., Data Quality: Inaccurate clinical data affecting patient records and statistics.
Mitigation Strategy
Ensure biopsy results confirm granulomatous inflammation before coding.
Impact
Failure to document laterality can lead to incorrect coding.
Mitigation Strategy
Implement mandatory fields for laterality in electronic health records.
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 Left Breast Abscess, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Left Breast Abscess
Use these documentation templates to ensure complete and accurate documentation for Left Breast Abscess. These templates include all required elements for proper coding and billing.
Left Breast Abscess Diagnosis
Specialty: General SurgeryRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Microbiology culture results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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