Is O91.011 a billable ICD-10-CM code?

Yes. O91.011 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does O91.011 sit in the tabular list?

Pregnancy, childbirth and the puerperium (O00-O9A), in the block Complications predominantly related to the puerperium (O85-O92).

O91.011

O91.011 — Infection of nipple associated with pregnancy, first trimester

Billable / specific codeICD-10-CM

O91.011 is a billable, specific ICD-10-CM code for infection of nipple associated with pregnancy, first trimester. It is valid for submission on a claim.

Risk adjustment

O91.011 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

O91.011 is named in 1 Medicare coverage policy — 1 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A56766Billing and Coding: Incision and Drainage (I&D) of Abscess of Skin, Subcutaneous and Accessory Structures

Related codes at this level

Codes that share O91.01. If O91.011 is not quite right, the correct code is usually one of these.

Questions about O91.011

Is O91.011 a billable ICD-10-CM code?: Yes. O91.011 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does O91.011 sit in the tabular list?: Pregnancy, childbirth and the puerperium (O00-O9A), in the block Complications predominantly related to the puerperium (O85-O92).