O91.13 — Abscess of breast associated with lactation
O91.13 is a billable, specific ICD-10-CM code for abscess of breast associated with lactation. It is valid for submission on a claim.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Mammary abscess associated with lactation
- Purulent mastitis associated with lactation
- Subareolar abscess associated with lactation
Risk adjustment
O91.13 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
O91.13 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
How O91.13 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 O91.13.
- Puerperal, puerperium›abscess›breast›associated with lactation
- Puerperal, puerperium›abscess›mammary›associated with lactation
- Puerperal, puerperium›abscess›subareolar›associated with lactation
- Puerperal, puerperium›fistula›breast›associated with lactation
- Puerperal, puerperium›mastitis›purulent›associated with lactation
- Suppuration, suppurative›mammary gland›puerperal, postpartum›associated with lactation
- Mastitis›obstetric›purulent›associated with›lactation
Related codes at this level
Codes that share O91.1. If O91.13 is not quite right, the correct code is usually one of these.
Questions about O91.13
- Is O91.13 a billable ICD-10-CM code?
- Yes. O91.13 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does O91.13 sit in the tabular list?
- Pregnancy, childbirth and the puerperium (O00-O9A), in the block Complications predominantly related to the puerperium (O85-O92).