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ICD-10 Guide
ICD-10 CodesChapter 15: Pregnancy, childbirth and the puerperiumO92

O92

Non-billable

Other disorders of breast and disorders of lactation associated with pregnancy and the puerperium

Chapter 15:Pregnancy, childbirth and the puerperium

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

Code Description

ICD-10 O92 is a used to indicate a diagnosis of other disorders of breast and disorders of lactation associated with pregnancy and the puerperium.

Key Diagnostic Point:

The ICD-10 category O92 encompasses various disorders of the breast and lactation issues that arise during pregnancy and the puerperium. This category includes conditions such as mastitis, galactorrhea, and other complications that may affect breastfeeding and maternal health. These disorders can significantly impact the mother's ability to breastfeed, which is essential for the infant's nutrition and bonding. Understanding these conditions is crucial for healthcare providers to offer appropriate interventions and support to new mothers.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of conditions covered
  • Potential for overlapping symptoms
  • Need for careful clinical assessment

Audit Risk Factors

  • Inadequate documentation
  • Misdiagnosis of breast disorders
  • Failure to recognize lactation complications

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

Pediatrics

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical impact of the O92 category is significant, as it addresses conditions that can affect maternal health and infant nutrition. Proper management of these disorders can lead to improved breastfeeding outcomes, which are crucial for infant development and maternal well-being. Administratively, accurate coding of O92 can influence quality measures and population health initiatives, as healthcare systems increasingly focus on maternal and child health metrics. Understanding the implications of these codes can help healthcare providers align their practices with current healthcare trends and improve overall care delivery.

ICD-9 vs ICD-10

The clinical impact of the O92 category is significant, as it addresses conditions that can affect maternal health and infant nutrition. Proper management of these disorders can lead to improved breastfeeding outcomes, which are crucial for infant development and maternal well-being. Administratively, accurate coding of O92 can influence quality measures and population health initiatives, as healthcare systems increasingly focus on maternal and child health metrics. Understanding the implications of these codes can help healthcare providers align their practices with current healthcare trends and improve overall care delivery.

Reimbursement & Billing Impact

Reimbursement may vary based on the complexity of the condition and the services rendered, so it is essential to stay updated on payer policies regarding these codes. Additionally, proper coding can help avoid denials and ensure timely payment for services.

Resources

Clinical References

  • •
    Official ICD-10 Guidelines for O92

Coding & Billing References

  • •
    Official ICD-10 Guidelines for O92

Frequently Asked Questions

What conditions are included in O92?

Conditions such as mastitis, galactorrhea, and other lactation disorders that may occur during pregnancy and the postpartum period are included in O92.

When should I use O92 codes?

Use O92 codes when documenting specific breast disorders or lactation issues that arise in the context of pregnancy or the puerperium, ensuring that the clinical scenario aligns with the definitions provided in the ICD-10 guidelines.

What documentation is required for O92?

Documentation should include a clear clinical description of the breast disorder or lactation issue, relevant patient history, and any treatments or interventions provided to support the diagnosis.