Is O91.012 a billable ICD-10-CM code?

Yes. O91.012 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does O91.012 sit in the tabular list?

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

O91.012

O91.012 — Infection of nipple associated with pregnancy, second trimester

Billable / specific codeICD-10-CM

O91.012 is a billable, specific ICD-10-CM code for infection of nipple associated with pregnancy, second trimester. It is valid for submission on a claim.

Risk adjustment

O91.012 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

O91.012 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

Code history

O91.012 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share O91.01. If O91.012 is not quite right, the correct code is usually one of these.

Questions about O91.012

Is O91.012 a billable ICD-10-CM code?: Yes. O91.012 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does O91.012 sit in the tabular list?: Pregnancy, childbirth and the puerperium (O00-O9A), in the block Complications predominantly related to the puerperium (O85-O92).