Is N61.0 a billable ICD-10-CM code?

Yes. N61.0 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does N61.0 sit in the tabular list?

Diseases of the genitourinary system (N00-N99), in the block Disorders of breast (N60-N65).

What cannot be coded together with N61.0?

N61.0 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above N61.0 (N61) and apply to it just the same.

N61.0

N61.0 — Mastitis without abscess

Billable / specific codeICD-10-CM

N61.0 is a billable, specific ICD-10-CM code for mastitis without abscess. It is valid for submission on a claim.

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Infective mastitis (acute) (nonpuerperal) (subacute)
Mastitis (acute) (nonpuerperal) (subacute) NOS
Cellulitis (acute) (nonpuerperal) (subacute) of breast NOS
Cellulitis (acute) (nonpuerperal) (subacute) of nipple NOS

Excludes1 inherited from the categories above N61.0

These are not written on N61.0, but they bind it: a note on a category applies to every code beneath it. Billing N61.0 with anything listed here is a denial.

Written on N61 — Inflammatory disorders of breast

inflammatory carcinoma of breast (C50.A-)
inflammatory disorder of breast associated with childbirth (O91.-)
neonatal infective mastitis (P39.0)
thrombophlebitis of breast [Mondor's disease] (I80.8)

Risk adjustment

N61.0 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Medicare coverage

N61.0 is named in 4 Medicare coverage policies — 4 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A52849Billing and Coding: Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography
A56448Billing and Coding: Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography
A56448Billing and Coding: Breast Imaging Mammography/Breast Echography (Sonography)/Breast MRI/Ductography
A56580Billing and Coding: Computerized Axial Tomography (CT), Thorax

How N61.0 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to N61.0.

Galactophoritis
Mammillitis
Mastitis(acute) (diffuse) (nonpuerperal) (subacute)
Thelitis
Cellulitis›breast(acute) (nonpuerperal) (subacute)
Cellulitis›nipple(acute) (nonpuerperal) (subacute)
Fistula›breast
Fistula›mammary(gland)
Infection, infected, infective›mammary gland
Infection, infected, infective›nipple
Inflammation, inflamed, inflammatory›areola
Inflammation, inflamed, inflammatory›breast

Code history

N61.0 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share N61. If N61.0 is not quite right, the correct code is usually one of these.

Questions about N61.0

Is N61.0 a billable ICD-10-CM code?: Yes. N61.0 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does N61.0 sit in the tabular list?: Diseases of the genitourinary system (N00-N99), in the block Disorders of breast (N60-N65).
What cannot be coded together with N61.0?: N61.0 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above N61.0 (N61) and apply to it just the same.