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ICD-10 Coding for Mastitis(N61.0, N61.22, O91.21)

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

Also known as:

Breast InfectionLactational MastitisGranulomatous Mastitis

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Related ICD-10 Code Ranges

Complete code families applicable to Mastitis

N61Primary Range

Inflammatory disorders of breast

This range includes various forms of mastitis, both acute and chronic, with or without abscess.

O91

Infections of breast associated with childbirth

This range is relevant for mastitis cases associated with pregnancy and the puerperium.

Code Comparison: When to Use Each Code

Compare key differences between these codes to ensure accurate selection

CodeDescriptionWhen to UseKey Documentation
N61.0Acute mastitis without abscessUse when acute mastitis is present without abscess formation.
  • Clinical signs of inflammation without abscess
  • CRP elevation
  • No ultrasound evidence of abscess
N61.22Granulomatous mastitis, left breastUse for confirmed granulomatous mastitis in the left breast.
  • Biopsy confirmation of granulomatous inflammation
  • Chronicity of symptoms
O91.21Nonpurulent mastitis associated with pregnancyUse for mastitis cases during pregnancy without abscess.
  • Pregnancy status confirmed
  • No abscess on imaging

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 mastitis

Essential facts and insights about Mastitis

The ICD-10 code for acute mastitis without abscess is N61.0. For granulomatous mastitis, use N61.22. If associated with pregnancy, use O91.21.

Primary ICD-10-CM Codes for mastitis

N61.0
Acute mastitis without abscess
Billable Code

Decision Criteria

clinical Criteria

  • No abscess formation on clinical exam or imaging

Applicable To

  • Acute mastitis without purulent drainage

Excludes

  • Mastitis with abscess (N61.1)

Clinical Validation Requirements

  • Clinical signs of inflammation without abscess
  • CRP elevation
  • No ultrasound evidence of abscess

Code-Specific Risks

  • Misclassification if abscess is present

Coding Notes

  • Ensure documentation specifies absence of abscess.
View Full Code Details

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

B95.61
Use when Staphylococcus aureus is identified as the causative organism.

Differential Codes

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

Abscess of breast and nipple

N61.1
Presence of abscess confirmed by imaging or clinical examination.

Acute mastitis without abscess

N61.0
Acute presentation without chronic granulomatous changes.

Documentation & Coding Risks

Avoid these common documentation and coding issues when documenting Mastitis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code N61.0.

Impact

Clinical: Inaccurate treatment records, Regulatory: Non-compliance with coding standards, Financial: Potential claim denials

Mitigation Strategy

Always document laterality, Use templates that prompt for laterality

Impact

Reimbursement: Potential underpayment due to incorrect code, Compliance: Non-compliance with ICD-10 guidelines, Data Quality: Inaccurate clinical data recording

Mitigation Strategy

Use N61.22 if granulomatous mastitis is confirmed.

Impact

Improper sequencing of mastitis and causative organism codes.

Mitigation Strategy

Train staff on correct sequencing rules.

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 Mastitis, with expert answers to help guide accurate code selection and documentation.

Documentation Templates for Mastitis

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

Acute mastitis without abscess

Specialty: Primary Care

Required Elements

  • Patient history
  • Clinical findings
  • Imaging results
  • Treatment plan

Example Documentation

Patient presents with left breast pain, erythema, and fever. No abscess on ultrasound. Diagnosis: Acute mastitis without abscess.

Examples: Poor vs. Good Documentation

Poor Documentation Example
Left breast pain.
Good Documentation Example
Acute mastitis without abscess, left breast, confirmed by ultrasound.
Explanation
The good example provides specific diagnosis and imaging confirmation.

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