2025 ICD-10-CM code N61
(Active) Effective Date: N/A Revision Date: N/A Diseases of the genitourinary system - Disorders of breast XIV Diseases of the genitourinary system Feed
Inflammatory disorders of the breast.
Medical necessity for using N61 codes hinges on the presence of objective signs and symptoms of an inflammatory breast condition. This may include pain, swelling, redness, warmth, fever, nipple discharge, or palpable masses.Documentation must clearly support the diagnosis and the chosen treatment approach.
Diagnosis and management of inflammatory breast conditions fall under the purview of various medical professionals, including primary care physicians, gynecologists, and general surgeons.Responsibilities include: accurate diagnosis through physical examination, imaging (mammography, ultrasound), and potentially biopsy; distinguishing between infectious and non-infectious causes; prescribing appropriate treatment (antibiotics, anti-inflammatory medications, pain management); patient education on breast care and hygiene; surgical intervention (incision and drainage for abscesses) when necessary; and follow-up care to monitor resolution and prevent recurrence.
In simple words: This code represents various inflammatory conditions affecting the breast, such as abscesses, carbuncles, and mastitis (inflammation), that aren't related to childbirth or the neonatal period.
Inflammatory disorders of breast. Includes: abscess (acute)(chronic)(nonpuerperal) of: areola; breast; carbuncle of breast; mastitis (acute)(subacute)(nonpuerperal): NOS; infective. Excludes1: inflammatory carcinoma of breast (C50.9); inflammatory disorder of breast associated with childbirth (O91.-); neonatal infective mastitis (P39.0); thrombophlebitis of breast [Mondor's disease] (I80.8)
Example 1: A 35-year-old non-lactating female presents with localized pain, redness, and swelling in her left breast. After examination and imaging, she is diagnosed with non-puerperal mastitis (N61.0) and treated with antibiotics., A 50-year-old male presents with a painful lump and redness around his nipple.He is diagnosed with a breast abscess (N61.1) and undergoes incision and drainage., A 40-year-old female with a history of lupus presents with recurring inflammation in her breast, not associated with infection or lactation.She is diagnosed with granulomatous mastitis (N61.2), a rare chronic inflammatory condition.
Documentation should include: patient's presenting symptoms, including onset, duration, and location of pain/swelling; physical exam findings (redness, warmth, tenderness, palpable mass); results of imaging studies (mammogram, ultrasound); biopsy results (if performed); diagnosis and clinical impression; treatment plan, including medications and/or procedures; and follow-up care.
** Accurate coding requires careful differentiation from other breast conditions. The documentation should support the specific type of inflammatory disorder.
- Specialties:Primary Care, Gynecology, General Surgery, Internal Medicine
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Independent Clinic