2025 ICD-10-CM code O92.11
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Pregnancy, childbirth and the puerperium - Complications predominantly related to the puerperium (O85-O92) Chapter XV: Pregnancy, childbirth and the puerperium (O00-O99) Feed
Cracked nipple associated with pregnancy.
Medical necessity is established by the presence of symptomatic cracked nipples directly related to or worsened by the pregnancy or postpartum period. Pain, bleeding, infection, and inability to breastfeed can justify clinical intervention and coding.
Obstetricians and gynecologists, family physicians, and midwives are primarily responsible for managing this condition, which often involves clinical assessment, counseling on breastfeeding techniques and management of potential complications.Lactation consultants may also be involved.
- Chapter XV: Pregnancy, childbirth and the puerperium (O00-O99)
- O92.11 is part of the broader category of complications predominantly related to the puerperium (O85-O92) within Chapter XV (O00-O99).
In simple words: This code is for a mother who has cracked nipples because of pregnancy or breastfeeding after delivery.
This code classifies a cracked nipple specifically associated with or aggravated by pregnancy, childbirth, or the puerperium.It is used only on maternal records, and not on newborn records.The condition must be directly related to or worsened by the pregnancy or postpartum period.
Example 1: A 28-year-old woman, G1P1, presents one week postpartum with bilateral cracked nipples and significant pain during breastfeeding. She reports inadequate latch initially, leading to friction and fissure formation. The pain is managed with nipple cream and repositioning instruction., A 35-year-old woman, G2P2, develops cracked nipples at 3 weeks postpartum, with persistent bleeding and pain.The cracks are deep and infected.Treatment includes topical antibiotics, pain medication, and temporary cessation of breastfeeding with pump and bottle feeding., A first-time mother, age 22 (G1P1), presents at 2 weeks postpartum with unilateral cracked nipple with minor pain. She is counseled on proper latch techniques, and instructed to apply lanolin cream and express breast milk to prevent further damage and pain.
Thorough documentation should include the following:
** Accurate coding requires clear documentation linking the cracked nipples directly to the pregnancy or postpartum period.If the cracked nipple is not causally related to the pregnancy or postpartum, this code should not be applied.
- Payment Status: Active
- Specialties:Obstetrics and Gynecology, Family Medicine
- Place of Service:Office, Hospital (Inpatient and Outpatient), Birthing Center