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ICD-10 Guide
ICD-10 CodesChapter 15: Pregnancy, childbirth and the puerperiumO91

O91

Non-billable

Infections of breast associated with pregnancy, the puerperium and lactation

Chapter 15:Pregnancy, childbirth and the puerperium

BILLABLE STATUSNo
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 O91 is a used to indicate a diagnosis of infections of breast associated with pregnancy, the puerperium and lactation.

Key Diagnostic Point:

The ICD-10 Level 1 Category code O91 pertains to infections of the breast that occur in association with pregnancy, the puerperium, and lactation. This category encompasses a variety of conditions, including mastitis and breast abscesses, which can arise during these critical periods. The clinical significance of O91 lies in its ability to identify and categorize infections that may complicate the postpartum period or affect breastfeeding, thus impacting both maternal and infant health. Proper coding is essential for effective treatment, management, and tracking of these conditions, which can lead to serious complications if left untreated.

  • Infections of the breast can lead to significant discomfort, systemic illness, and may require interventions such as antibiotics or surgical drainage. The usage guidelines for O91 codes emphasize the importance of accurate diagnosis and documentation, as these infections can vary in severity and may necessitate different treatment approaches. Clinicians should be vigilant in monitoring for signs of infection in postpartum patients, especially those who are breastfeeding, to ensure timely and appropriate care.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of infections covered
  • Potential for complications
  • Need for accurate documentation

Audit Risk Factors

  • Inadequate documentation of symptoms
  • Misclassification of infection severity
  • Failure to follow up on treatment outcomes

Specialty Focus

Medical Specialties

Obstetrics

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Breast Surgery

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical impact of the O91 code category is significant, as it directly relates to maternal health and the successful initiation of breastfeeding. Infections of the breast can lead to complications that affect both the mother and infant, potentially resulting in prolonged hospital stays or additional medical interventions. By accurately coding these conditions, healthcare providers can better monitor trends in maternal health and the effectiveness of interventions aimed at preventing and treating infections.
Administratively, the use of O91 codes can influence healthcare quality measures and reporting. Tracking the incidence of breast infections during pregnancy and lactation can provide valuable insights into healthcare practices and outcomes, guiding improvements in care delivery. Furthermore, understanding the prevalence of these conditions can help shape public health initiatives aimed at supporting breastfeeding and maternal health, ultimately contributing to better health outcomes for mothers and their infants.

ICD-9 vs ICD-10

The clinical impact of the O91 code category is significant, as it directly relates to maternal health and the successful initiation of breastfeeding. Infections of the breast can lead to complications that affect both the mother and infant, potentially resulting in prolonged hospital stays or additional medical interventions. By accurately coding these conditions, healthcare providers can better monitor trends in maternal health and the effectiveness of interventions aimed at preventing and treating infections. Administratively, the use of O91 codes can influence healthcare quality measures and reporting. Tracking the incidence of breast infections during pregnancy and lactation can provide valuable insights into healthcare practices and outcomes, guiding improvements in care delivery. Furthermore, understanding the prevalence of these conditions can help shape public health initiatives aimed at supporting breastfeeding and maternal health, ultimately contributing to better health outcomes for mothers and their infants.

Reimbursement & Billing Impact

reimbursement may depend on the specificity of the diagnosis and the documentation provided. It is essential for healthcare providers to ensure that all relevant clinical information is included in the patient's medical record, as this will support the medical necessity of the services rendered. Common billing practices include using appropriate modifiers and ensuring that the CPT codes align with the diagnoses documented.

Resources

Clinical References

  • •
    Official ICD-10 Guidelines for O91

Coding & Billing References

  • •
    Official ICD-10 Guidelines for O91

Frequently Asked Questions

What conditions are included in O91?

O91 includes conditions such as mastitis, breast abscesses, and other infections that occur during pregnancy, the puerperium, and lactation.

When should I use O91 codes?

O91 codes should be used when diagnosing infections of the breast that are directly related to pregnancy, childbirth, or lactation, particularly when these conditions require medical intervention.

What documentation is required for O91?

Documentation should include clinical findings, treatment plans, and any relevant history of breastfeeding or complications during pregnancy and postpartum periods.