ICD-10-CM Billable Code

N61.1

Abscess of the breast and nipple

Clinical Classification Guidelines

Inclusion Terms

  • Abscess (acute) (chronic) (nonpuerperal) of areola
  • Abscess (acute) (chronic) (nonpuerperal) of breast
  • Carbuncle of breast
  • Mastitis with abscess

Medical Intelligence & Overview

An abscess of the breast and nipple is a localized infection that results in a collection of pus within the tissues. This condition can affect various parts of the breast, including the areola, and may develop suddenly or over time. It often causes discomfort and swelling, and requires medical evaluation for appropriate treatment.

Causes & Symptoms

Clinical Causes: Bacterial infections, most commonly Staphylococcus aureus, entering through a cracked or damaged skin area. Blocked milk ducts during breastfeeding leading to localized infection. Trauma or injury to the breast area which facilitates bacterial invasion. Chronic skin conditions or infections that spread to deeper tissues. Previous breast surgery or procedures that breach the skin barrier. Poor hygiene or immune system deficiencies that impair infection control.

Key Symptoms: Localized swelling and tenderness in the affected breast or areola. Presence of a palpable lump or mass that may be painful. Redness and heat over the affected area indicating inflammation. Fever and chills, especially in cases with systemic infection. Discharge from the nipple, which may be pus-like in appearance. General discomfort or feeling of unwellness.

Diagnostic & Treatment

Diagnosis Path: Diagnosis primarily involves a physical examination by a healthcare provider assessing the affected breast for signs of infection. Imaging tests like ultrasound can help identify fluid collections and distinguish abscesses from other lumps. A sample of the pus or tissue may be taken for laboratory testing to identify the infectious organism. Blood tests can also be performed to evaluate for signs of systemic infection.

Treatment Protocols: Drainage of the abscess, often through needle aspiration or surgical incision and drainage to remove pus and relieve pressure. Antibiotic therapy tailored based on bacterial culture results to eliminate the infection. Pain management through over-the-counter medications or prescribed analgesics. Supportive measures such as warm compresses to promote drainage and reduce discomfort. Proper wound care and hygiene to prevent recurrence and promote healing. Addressing any underlying issues like blocked ducts or skin conditions to prevent future abscesses.

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 N61.1 a billable ICD-10 code?
Yes, N61.1 is a specific, billable code that can be used to indicate a diagnosis for reimbursement purposes.

Documentation

How do I report N61.1?
Clinical documentation must specify the nature of Abscess of the breast and nipple and any associated comorbidities for accurate reporting.

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