2027 ICD-10-CM Diagnosis Code O91.13Abscess of breast associated with lactation
ICD-10-CM Codes›O00-O9A›O85-O92›O91
- Billable — Valid for Submission
- Not Chronic
O91.13 is a billable ICD-10-CM diagnosis code for abscess of breast associated with lactation. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 769, 776. The code is restricted by the Medicare Code Editor to maternity cases (age 9 through 64). In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Complications specified during the puerperium and Nonmalignant breast conditions.
Code Identity
Code Classification
Code EditsBilling
Medicare Code Editor checks that affect claim validity for O91.13.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Abscess of breast, associated with childbirth
- Abscess of left breast with lactation
- Abscess of nipple
- Abscess of nipple associated with childbirth
- Abscess of right breast with lactation
- Breast abscess during lactation
- Mastitis associated with lactation
- Obstetric abscess of breast
- Obstetric abscess of nipple
- Purulent mastitis during lactation
- Purulent mastitis of left breast during lactation
- Purulent mastitis of right breast during lactation
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to O91.13: its own notes plus those printed at O91, block O85-O92, and Chapter 15. A note printed at a category, block or chapter applies to every code under it.
Applicable To
Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.
- Mammary abscess associated with lactation
- Purulent mastitis associated with lactation
- Subareolar abscess associated with lactation
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
- supervision of normal pregnancy (Z34.-)
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
Use Additional Code
Add a second code, after this one, to fully describe the condition.
- code to identify infection
- code, if applicable, from category Z3A, Weeks of gestation, to identify the specific week of the pregnancy, if known.
Notes
General instructions on how these codes are used.
- CODES FROM THIS CHAPTER ARE FOR USE ONLY ON MATERNAL RECORDS, NEVER ON NEWBORN RECORDS
- Codes from this chapter are for use for conditions related to or aggravated by the pregnancy, childbirth, or by the puerperium (maternal causes or obstetric causes)
- Trimesters are counted from the first day of the last menstrual period. They are defined as follows:
- 1st trimester- less than 14 weeks 0 days
- 2nd trimester- 14 weeks 0 days to less than 28 weeks 0 days
- 3rd trimester- 28 weeks 0 days until delivery
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name O91.13, its category, or a range that includes it.
Excludes1 2
These codes carry an Excludes1 note naming O91.13: they are not reported together with it, unless the two conditions are unrelated.
- N61 Inflammatory disorders of breastinflammatory disorder of breast associated with childbirth (O91.-) names O91.-, which includes this code
- Block N60-N65 Disorders of breast
Index to Diseases and InjuriesGuidance
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Abscess
An abscess is a pocket of pus. You can get an abscess almost anywhere in your body. When an area of your body becomes infected, your body's immune system tries to fight the infection. White blood cells go to the infected area, collect within the damaged tissue, and cause inflammation. During this process, pus forms.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert O91.13 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About O91.13Overview
What is the ICD-10 code for abscess of breast associated with lactation?
The ICD-10-CM code for abscess of breast associated with lactation is O91.13 (sometimes written as O9113). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is O91.13 a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report abscess of breast associated with lactation on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does O91.13 group to?
When abscess of breast associated with lactation is the principal diagnosis on an inpatient stay, it groups to MS-DRG 769, 776, with relative weights from 0.6718 to 1.6666 depending on complications. Higher weights mean higher Medicare reimbursement.
Who can O91.13 be reported for?
The Medicare Code Editor checks abscess of breast associated with lactation against patient demographics: this code is intended for maternity cases (age 9 through 64). Claims outside these limits are flagged as inconsistent.
Does O91.13 need an additional code?
When the condition applies, yes. The Use Additional Code note at O91, which applies to O91.13, reads: code to identify infection. The additional code is reported after O91.13.
