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v1.0.0
ICD-10 Guide
ICD-10 CodesN61.1

N61.1

Billable

Abscess of the breast and nipple

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/18/2025

Code Description

ICD-10 N61.1 is a billable code used to indicate a diagnosis of abscess of the breast and nipple.

Key Diagnostic Point:

An abscess of the breast and nipple is a localized collection of pus that occurs within the breast tissue or at the nipple, often resulting from infection. This condition is typically associated with mastitis, which is an inflammation of breast tissue that can lead to infection. Abscesses may present as painful, swollen areas in the breast, and can be accompanied by systemic symptoms such as fever and malaise. Patients may also experience nipple discharge, which can be purulent in nature. Diagnosis is often confirmed through clinical examination and imaging studies, such as ultrasound, which can help differentiate between an abscess and other breast conditions like benign lumps or malignancies. Treatment usually involves antibiotics and may require surgical intervention for drainage of the abscess. Understanding the underlying causes, such as breastfeeding complications or ductal obstruction, is crucial for effective management and prevention of recurrence.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between abscess and other breast conditions
  • Need for imaging studies to confirm diagnosis
  • Potential for co-existing conditions like mastitis
  • Variability in presentation and symptoms among patients

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to document imaging results
  • Misclassification of abscess severity
  • Lack of follow-up documentation post-treatment

Specialty Focus

Medical Specialties

General Surgery

Documentation Requirements

Detailed operative notes and post-operative care plans are essential.

Common Clinical Scenarios

Surgical drainage of breast abscesses, management of recurrent abscesses.

Billing Considerations

Ensure clear documentation of the abscess location, size, and any complications.

Obstetrics and Gynecology

Documentation Requirements

Comprehensive patient history, including breastfeeding status and previous breast conditions.

Common Clinical Scenarios

Management of breast abscesses in lactating women, evaluation of nipple discharge.

Billing Considerations

Document any relevant obstetric history that may contribute to breast conditions.

Coding Guidelines

Inclusion Criteria

Use N61.1 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of the abscess's characteristics and any associated conditions
  • Include relevant imaging studies and treatment plans in the documentation

Exclusion Criteria

Do NOT use N61.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

10060CPT Code

Incision and drainage of abscess

Clinical Scenario

Used when a breast abscess requires surgical drainage.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

General surgery documentation standards apply.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of breast conditions, improving the accuracy of diagnoses and treatment tracking for abscesses.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of breast conditions, improving the accuracy of diagnoses and treatment tracking for abscesses.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of breast conditions, improving the accuracy of diagnoses and treatment tracking for abscesses.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What are the common causes of breast abscesses?

Breast abscesses are commonly caused by bacterial infections, often related to breastfeeding, ductal obstruction, or trauma to the breast tissue.