2025 ICD-10-CM code O91.03
Infection of the nipple associated with lactation.
Medical necessity for the code O91.03 is established by the presence of signs and symptoms of a nipple infection, such as pain, redness, swelling, cracking, or discharge, occurring during lactation. The documentation should support the diagnosis and the need for medical intervention to resolve the infection and enable continued breastfeeding.
The physician is responsible for diagnosing and treating the nipple infection, which may involve prescribing antifungals or antibiotics, pain relievers, and advising on breastfeeding practices. They should also provide education on proper hygiene and nipple care to prevent recurrence.
- Chapter 15: Pregnancy, childbirth and the puerperium (O00-O9A)
- O91.0 Infection of nipple associated with pregnancy, the puerperium and lactationO91.03 Infection of nipple associated with lactation
In simple words: Nipple infection related to breastfeeding.
Infection of the nipple associated with breastfeeding.
Example 1: A 32-year-old female, two weeks postpartum, presents with severe nipple pain, redness, and cracking on her right nipple. The patient reports the pain worsens after breastfeeding. Upon examination, the physician diagnoses a nipple infection and prescribes an antifungal cream and pain medication., A 28-year-old female, one month postpartum, complains of persistent left nipple pain and a burning sensation during and after breastfeeding. She has noticed white patches on her baby's tongue. The physician diagnoses a thrush infection (candidiasis) of the nipple and prescribes an antifungal treatment for both mother and baby., A 35-year-old postpartum woman, three weeks after delivery, experiences fever, chills, and a warm, red, and tender area on her left breast along with nipple pain. She is diagnosed with mastitis with a secondary nipple infection. The physician prescribes antibiotics and advises her to continue breastfeeding to help drain the affected breast.
Documentation should include details of the onset, duration, and character of nipple pain, associated symptoms like fever or breast tenderness, presence of cracks or fissures, any visible signs of infection on the nipple or in the baby's mouth, and response to treatment. It's crucial to document the baby's symptoms and treatment if thrush is suspected.
** It's essential to differentiate between nipple pain caused by improper latch or positioning and actual infection. Education on correct breastfeeding techniques and nipple care can help prevent infections. If a breast abscess develops, additional coding may be required.
- Payment Status: Active
- Specialties:Obstetrics and Gynecology, Family Medicine, Lactation Consultants
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Home Health