2025 ICD-10-CM code O91.13
(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 18: Pregnancy, childbirth and the puerperium (O00-O9A) Feed
Abscess of the breast associated with lactation.
Medical necessity is established by the presence of clinical findings consistent with a breast abscess (pain, swelling, redness, fluctuance) and confirmation with imaging (ultrasound) and/or aspiration.Antibiotic therapy and/or incision and drainage are medically necessary to treat the infection and prevent further complications.
Diagnosis and management of breast abscess, including assessment of symptoms, physical examination, diagnostic testing (e.g., ultrasound, aspiration), and treatment (e.g., incision and drainage, antibiotics).May involve referral to a surgeon for more complex cases.
- Chapter 18: Pregnancy, childbirth and the puerperium (O00-O9A)
- O91 Infections of breast associated with pregnancy, the puerperium and lactation
In simple words: This code describes a pus-filled pocket (abscess) that develops in the breast during breastfeeding. This is a complication after childbirth and usually results from an infection.
This code is used to classify an abscess of the breast that occurs in association with lactation.It specifically refers to a localized collection of pus within the breast tissue during the period of breastfeeding.The abscess may be subareolar (beneath the areola) or located elsewhere in the breast tissue.This condition is a complication of puerperium (the period after childbirth) and usually arises from an infection, often mastitis.
Example 1: A 32-year-old woman, three weeks postpartum, presents with breast pain, redness, and swelling in her right breast, accompanied by fever and chills.Physical examination reveals a fluctuant mass consistent with an abscess.Ultrasound confirms the abscess, and incision and drainage are performed.Antibiotics are prescribed. O91.13 is assigned., A 28-year-old breastfeeding mother reports a painful lump in her left breast for the past week.The area is erythematous and tender to the touch.She is afebrile.The physician suspects a breast abscess and orders an ultrasound.The imaging study shows an abscess that requires incision and drainage. O91.13 is used., A 35-year-old patient, six weeks postpartum, is seen for a follow-up appointment.She reports initial resolution of mastitis but now has a localized area of persistent inflammation and swelling.A small abscess is identified on physical examination.Aspiration and antibiotic treatment are initiated. O91.13 is assigned.
Complete patient history including pregnancy and postpartum course, symptoms (e.g., breast pain, swelling, redness, fever), physical examination findings, imaging results (e.g., ultrasound, mammogram), laboratory results (e.g., complete blood count), and details of treatment (e.g., incision and drainage, antibiotics).
** This code is for use in cases of breast abscess directly associated with lactation.If the abscess is unrelated to lactation or pregnancy, a different code should be used.Always ensure proper documentation to support the code assignment.
- Payment Status: Active
- Specialties:Obstetrics, Gynecology, Family Medicine
- Place of Service:Office, Hospital Inpatient, Hospital Outpatient, Ambulatory Surgical Center