ICD-10-CM Billable Code

O91.1

Abscess of breast associated with pregnancy, the puerperium and lactation

Clinical Classification Guidelines

Medical Intelligence & Overview

A breast abscess during pregnancy or lactation is a localized infection that results in a painful, swollen lump filled with pus within the breast tissue. This condition commonly affects women who are pregnant or breastfeeding, as hormonal and physiological changes can increase vulnerability. Recognizing the symptoms early and understanding the causes can facilitate prompt management and relief.

Causes & Symptoms

Clinical Causes: Bacterial infection, most commonly involving Staphylococcus aureus Blocked milk ducts leading to bacterial growth Cracked or damaged nipples providing entry points for bacteria Poor breast hygiene or incomplete emptying of the breast during breastfeeding Previous breast infections or abscesses

Key Symptoms: Localized swelling and tenderness in the breast Presence of a firm, warm, and red lump Pain that may be continuous or worsening over time Possible fever and chills indicating systemic infection Discharge of pus or thick fluid from the nipple General feelings of fatigue and malaise

Diagnostic & Treatment

Diagnosis Path: Diagnosis typically involves a physical examination of the affected breast, noting swelling, redness, or tenderness. Imaging studies, such as ultrasound, can identify abscesses and differentiate them from other breast conditions. In some cases, a sample of the pus or fluid may be collected via needle aspiration for laboratory analysis to identify the causative bacteria. Blood tests may help assess for signs of infection or systemic response.

Treatment Protocols: Antibiotic therapy tailored to the suspected or confirmed bacteria Drainage of the abscess through needle aspiration or surgical incision if necessary Continued breastfeeding or milk expression to relieve milk duct blockage Pain management with appropriate medications Maintaining good breast hygiene practices Monitoring for signs of worsening infection, such as increased redness, swelling, or fever

Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes.

Clinical Advice & FAQs

Billing Guidance

Is O91.1 a billable ICD-10 code?
Yes, O91.1 is a specific, billable code that can be used to indicate a diagnosis for reimbursement purposes.

Documentation

How do I report O91.1?
Clinical documentation must specify the nature of Abscess of breast associated with pregnancy, the puerperium and lactation and any associated comorbidities for accurate reporting.

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lactation abscess associated puerperium