2025 ICD-10-CM code O91
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Complications predominantly related to the puerperium - Infections of breast associated with pregnancy, the puerperium, and lactation Chapter 18: Pregnancy, childbirth, and the puerperium (O00-O9A) Feed
Infections of the breast associated with pregnancy, childbirth, or lactation.
Modifiers may be applicable depending on the specific services rendered (e.g., for anesthesia, surgical assistance). Consult the appropriate modifier guidelines.
Medical necessity is established by the presence of symptoms and signs consistent with a breast infection (pain, redness, swelling, fever, purulent discharge).Appropriate diagnostic testing helps confirm the diagnosis and guides treatment decisions.
Obstetricians, gynecologists, and other healthcare professionals involved in maternal care are responsible for diagnosing and managing breast infections in pregnant, postpartum, and breastfeeding women.This involves taking a thorough history, performing a physical examination, ordering necessary tests (such as cultures), and prescribing appropriate treatment.
- Chapter 18: Pregnancy, childbirth, and the puerperium (O00-O9A)
- O85-O92: Complications predominantly related to the puerperium
In simple words: This code is for infections in a mother's breast that happen during pregnancy, after childbirth, or while breastfeeding.This can include breast inflammation, pus-filled areas, or infected nipples. The doctor may use additional codes to be more specific about the type of infection.
This code encompasses various infections of the breast that occur during pregnancy, the postpartum period (puerperium), or while breastfeeding (lactation).These infections can include mastitis (inflammation of the breast tissue), abscesses (localized collections of pus), and nipple infections.The specific type of infection should be further specified using additional codes if known (e.g., O91.0, O91.1, O91.2, etc., which may require additional digits depending on the encounter and trimester).The code should only be used for maternal records, never for newborn records.
Example 1: A 32-year-old woman, two weeks postpartum, presents with breast pain, redness, and swelling in her right breast.Physical examination reveals localized tenderness and warmth. A diagnosis of postpartum mastitis (O91.23) is made., A 28-year-old woman at 36 weeks gestation experiences a painful, fluctuant mass in her left breast.Ultrasound confirms a breast abscess (O91.13)., A breastfeeding mother, 6 weeks postpartum, reports cracked nipples and localized infection.Physical exam shows erythema and purulent drainage. The diagnosis is nipple infection associated with lactation (O91.03).
Detailed documentation is required, including patient history (pregnancy, childbirth, lactation status), physical exam findings (breast tenderness, redness, swelling, discharge), diagnostic tests (cultures, imaging studies), and treatment provided (antibiotics, incision and drainage).
** This code is exclusively for use in maternal records.Never use this code on a newborn's record.Always code the specific type of infection if known.The trimester of pregnancy (or postpartum period) should be documented when applicable using an additional code.The appropriate encounter (initial, subsequent, sequela) should be indicated with a seventh character if necessary.
- Payment Status: Active
- Specialties:Obstetrics, Gynecology
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Birthing Center