O91.0 ICD-10-CM Code: Infection of nipple associated with pregnancy, the puerperium and lactation

O91.0 is the ICD-10-CM diagnosis code for infection of nipple associated with pregnancy, the puerperium and lactation. O91.0 sits in the ICD-10-CM chapter for pregnancy, childbirth and the puerperium (o00-o9a), within the section covering complications predominantly related to the puerperium (o85-o92).

Header codes like O91.0 cannot be reported on claims directly, they organize child codes that share clinical context but the actual diagnosis must be coded to the highest level of specificity supported by the documentation. Coders should look at O91.0's child codes and select the one that matches the patient's documented presentation, since payers reject header codes submitted as the primary diagnosis. For risk adjustment workflows, header codes never contribute to a Medicare Advantage member's RAF score on their own; only billable child codes that happen to map to a payment HCC affect risk-adjusted plan payments.