Facebook tracking pixel
N61
ICD-10-CM
Mastitis

Find comprehensive information on mastitis diagnosis, including clinical documentation, ICD-10 codes (N61, O91.0, P39.0), SNOMED CT concepts, and medical coding guidelines. Learn about symptoms, treatment, and lactation mastitis for accurate healthcare records and billing. Explore resources for healthcare professionals on diagnosing puerperal mastitis and breast abscess related to mastitis. This resource supports proper clinical documentation and coding for mastitis in medical records.

Also known as

Breast Infection
Lactational Mastitis
Granulomatous Mastitis

Diagnosis Snapshot

Key Facts
  • Definition : Inflammation of breast tissue, often involving infection.
  • Clinical Signs : Breast pain, swelling, redness, warmth, fever, nipple discharge.
  • Common Settings : Postpartum/breastfeeding, blocked milk ducts, nipple trauma.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC N61 Coding
N64.-

Mastitis

Inflammation of the breast tissue, often related to breastfeeding.

O91.-

Infections of breast associated with childbirth

Infections in the breast occurring during the postpartum period.

P39.-

Infections specific to the perinatal period

Various infections affecting newborns or mothers around childbirth.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the mastitis puerperal (related to childbirth)?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Breast inflammation, usually infection.
Breast abscess
Mammary duct ectasia

Documentation Best Practices

Documentation Checklist
  • Mastitis diagnosis documentation: laterality, location
  • Document nipple condition: cracked, fissured, etc.
  • Inflammatory signs: redness, swelling, warmth, tenderness
  • Systemic symptoms: fever, chills, body aches documented
  • Lactation status: breastfeeding, duration, milk supply

Coding and Audit Risks

Common Risks
  • Unspecified Laterality

    Coding mastitis without specifying right, left, or bilateral breast can lead to rejected claims and inaccurate data reporting. CDI should query for laterality.

  • Lactation Status Confusion

    Incorrectly coding lactation status (puerperal vs. non-puerperal) impacts severity and treatment. CDI should clarify documentation.

  • Infective vs. Non-infective

    Differentiating between infective and non-infective mastitis is crucial for accurate coding and treatment. Vague documentation poses audit risks.

Mitigation Tips

Best Practices
  • Accurate ICD-10 coding (N61.*, O91.*, P39.0) for mastitis improves CDI
  • Document laterality, causative organism, and severity for proper HCC coding
  • Timely follow-up care documentation supports RAF scores and compliance
  • Standardized terminology for mastitis symptoms ensures data integrity for CDI
  • Query physicians for clarification on unspecified mastitis diagnoses for optimal reimbursement

Clinical Decision Support

Checklist
  • Verify breast pain, redness, swelling: ICD-10 N61, O91.0
  • Confirm fever, chills, malaise: ICD-10 O86.0, R50.9
  • Check milk abnormalities, if lactating: ICD-10 O92.6
  • Exclude abscess, other infections: Document differential diagnosis
  • Patient education: Breastfeeding support, medication adherence

Reimbursement and Quality Metrics

Impact Summary
  • Mastitis reimbursement hinges on accurate ICD-10 coding (N61.-, O91, P39.0) and timely claim submission maximizing hospital revenue.
  • Quality metrics for mastitis focus on appropriate antibiotic use, patient education, and timely treatment impacting hospital readmission rates.
  • Coding errors for mastitis (e.g., unspecified vs. puerperal) lead to claim denials and reduced reimbursement impacting hospital finances.
  • Accurate mastitis documentation supports quality reporting initiatives related to maternal health and infection control impacting hospital quality scores.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes. Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Code N61 Mastitis
  • Document lactation status
  • Specify infective agent if known
  • Rule out abscess (N61.1)
  • Consider laterality (right/left)

Documentation Templates

Patient presents with symptoms consistent with mastitis.  Chief complaint includes breast pain, tenderness, swelling, and redness, possibly accompanied by fever, chills, and flu-like symptoms.  Area of inflammation and induration may be palpable on physical examination.  Patient reports breastfeeding or recent cessation of breastfeeding, though mastitis can occur in non-lactating women as well.  Possible contributing factors include nipple trauma, milk stasis, blocked milk duct, or bacterial infection, most commonly Staphylococcus aureus.  Differential diagnosis includes breast abscess, plugged duct, galactocele, and inflammatory breast cancer.  Diagnostic workup may include breast ultrasound to rule out abscess formation.  Treatment plan includes frequent breastfeeding or milk expression, warm compresses, pain management with ibuprofen or acetaminophen, and antibiotic therapy targeting Staphylococcus aureus coverage, such as dicloxacillin or cephalexin.  Patient education provided regarding proper breastfeeding techniques, breast hygiene, and complete antibiotic course adherence.  Follow-up appointment scheduled to assess treatment response and resolution of symptoms.  ICD-10 code: O91.  Lactation status documented.  Severity of mastitis noted (e.g., mild, moderate, severe).