Version 2024

2024 ICD-10-CM Diagnosis Code N61.1

Abscess of the breast and nipple

ICD-10-CM Code:: N61.1
ICD-10 Code for:: Abscess of the breast and nipple
Is Billable?: Yes - Valid for Submission
Chronic Condition Indicator: ^[1]: Not chronic
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Code Information
Approximate Synonyms
Clinical Classification
Tabular List of Diseases and Injuries
Index to Diseases and Injuries References
Diagnostic Related Groups Mapping
Replacement Code
Convert to ICD-9 Code
Patient Education
Other Codes Used Similar Conditions
Code History

Code Classification

Diseases of the genitourinary system
(N00–N99)
- Disorders of breast
  (N60-N65)
  - Inflammatory disorders of breast
    (N61)

N61.1 is a billable diagnosis code used to specify a medical diagnosis of abscess of the breast and nipple. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024.

Approximate Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

Abscess of breast
Abscess of breast, associated with childbirth
Abscess of chest wall
Abscess of nipple
Abscess of nipple
Abscess of nipple - obstetric
Abscess of skin of breast
Acute abscess of areola
Acute abscess of breast
Acute mastitis
Acute mastitis
Carbuncle of breast
Carbuncle of chest wall
Carbuncle of pectoral region
Cellulitis and abscess of breast
Cellulitis and abscess of trunk
Cellulitis of breast
Cellulitis of pectoral region
Chronic abscess of areola
Chronic abscess of breast
Chronic disease of breast
Chronic disease of breast
Chronic disease of breast
Chronic disease of breast
Chronic non-puerperal breast abscess
Chronic subareolar non-puerperal abscess
Furuncle of breast
Furuncle of chest wall
Furuncle of pectoral region
Intramammary breast abscess
Mammary fistula
Nonpuerperal abscess of areola
Nonpuerperal abscess of areola
Nonpuerperal abscess of breast
Nonpuerperal abscess of breast
Nonpuerperal abscess of breast
Nonpuerperal abscess of left areola
Nonpuerperal abscess of left breast
Nonpuerperal abscess of left breast
Nonpuerperal abscess of right areola
Nonpuerperal abscess of right breast
Nonpuerperal abscess of right breast
Obstetric breast abscess
Obstetric breast abscess
Obstetric breast abscess
Obstetric breast abscess
Postpartum abscess of breast
Postpartum abscess of breast
Postpartum abscess of breast
Retromammary abscess associated with childbirth
Retromammary breast abscess
Retromammary breast abscess
Streptococcal mastitis
Subareolar abscess associated with childbirth
Subareolar breast abscess
Subareolar breast abscess
Subareolar breast abscess
Submammary abscess associated with childbirth

Clinical Classification

Clinical Category is Nonmalignant breast conditions
CCSR Category Code: GEN017
Inpatient Default CCSR: Y - Yes, default inpatient assignment for principal diagnosis or first-listed diagnosis.
Outpatient Default CCSR: Y - Yes, default outpatient assignment for principal diagnosis or first-listed diagnosis.

Tabular List of Diseases and Injuries

The following annotation back-references are applicable to this diagnosis code. The Tabular List of Diseases and Injuries is a list of ICD-10-CM codes, organized "head to toe" into chapters and sections with coding notes and guidance for inclusions, exclusions, descriptions and more.

Inclusion Terms

Abscess (acute) (chronic) (nonpuerperal) of areola
Abscess (acute) (chronic) (nonpuerperal) of breast
Carbuncle of breast
Mastitis with abscess

Index to Diseases and Injuries References

The following annotation back-references for this diagnosis code are found in the injuries and diseases index. The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10-CM code(s).

- Abscess (connective tissue) (embolic) (fistulous) (infective) (metastatic) (multiple) (pernicious) (pyogenic) (septic) - L02.91
- - areola (acute) (chronic) (nonpuerperal) - N61.1
- - breast (acute) (chronic) (nonpuerperal) - N61.1
- - nipple - N61.1

- Carbuncle - L02.93
- - breast - N61.1

- Furuncle - L02.92
- - breast - N61.1

- Mastitis (acute) (diffuse) (nonpuerperal) (subacute) - N61.0
- - with abscess - N61.1

- Suppuration, suppurative - See Also: condition;
- - breast - N61.1
- - mammary gland - N61.1

- Ulcer, ulcerated, ulcerating, ulceration, ulcerative
- - breast - N61.1

N61.1 is grouped with Diagnostic Related Groups - MS-DRG Mapping

Diagnostic Related Groups (DRGs) are a classification system used to group together diagnosis codes for the purpose of reimbursement and healthcare management. DRGs are used to standardize the way hospitals and other providers are paid for inpatient services. In this system patients are grouped together based on their principal diagnosis in areas referred to as Major Diagnostic Categories (MDC). Once a patient is assigned a particular diagnostic category, providers receive a predetermined payment rate for the services rendered. This reimbursement rate is often fixed and is meant to cover the cost of care for that patient. Reimbursement is also affected by the relative weight of a diagnostic related group based on the severity of a patient's illness and the associated cost of care during hospitalization.

Diagnostic related groups encourage healthcare providers to focus on quality and efficiency in patient care while managing costs effectively. The diagnosis code is present in the following groups for version MS-DRG V41.0 applicable from 10/01/2023 through 09/30/2024.

MS-DRG	MS-DRG Title	MCD	Relative Weight
600	NON-MALIGNANT BREAST DISORDERS WITH CC/MCC	09	1.0255
601	NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC	09	0.6226

The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.

Replacement Code

N611 replaces the following previously assigned ICD-10-CM code(s):

N61 - Inflammatory disorders of breast

Convert N61.1 to ICD-9-CM

ICD-9-CM Code: 611.0 - Inflam disease of breast
Approximate Flag - The approximate mapping means there is not an exact match between the ICD-10 and ICD-9 codes and the mapped code is not a precise representation of the original code.

Patient Education

Breast Diseases

Most women experience breast changes at some time. Your age, hormone levels, and medicines you take may cause lumps, bumps, and discharges (fluids that are not breast milk).

If you have a breast lump, pain, discharge or skin irritation, see your health care provider. Minor and serious breast problems have similar symptoms. Although many women fear cancer, most breast problems are not cancer.

Some common breast changes are:

Fibrocystic breast changes - lumpiness, thickening and swelling, often just before a woman's period
Cysts - fluid-filled lumps
Fibroadenomas - solid, round, rubbery lumps that move easily when pushed, occurring most in younger women
Intraductal papillomas - growths similar to warts near the nipple
Blocked milk ducts
Milk production when a woman is not breastfeeding

NIH: National Cancer Institute

[Learn More in MedlinePlus]

Code History

FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018

Footnotes

[1] Not chronic - A diagnosis code that does not fit the criteria for chronic condition (duration, ongoing medical treatment, and limitations) is considered not chronic. Some codes designated as not chronic are acute conditions. Other diagnosis codes that indicate a possible chronic condition, but for which the duration of the illness is not specified in the code description (i.e., we do not know the condition has lasted 12 months or longer) also are considered not chronic.