ICD-10 Code O92.3: Agalactia diagnosis, coding, and billing guide

Key Takeaways

ICD-10 Code O92.3 is the billable ICD-10-CM diagnosis code for agalactia, the absence or failure of breast milk production following childbirth.

O92.3 is current for FY2026 (effective for dates of service October 1, 2025 – September 30, 2026) and belongs to Chapter XV (Pregnancy, childbirth and the puerperium), Block O85-O92, Category O92.

Approximate synonyms include failure of lactation, inability to breastfeed, and primary agalactia; O92.3 carries an Excludes1 note for secondary, elective, and therapeutic agalactia, which are coded instead to O92.5 (suppressed lactation).

Pabau’s OB/GYN EMR and claims management tools support accurate ICD-10-CM code attachment and documentation at the point of postpartum care.

ICD-10 Code O92.3 is a billable ICD-10-CM diagnosis code for agalactia: the absence or failure of breast milk secretion following childbirth. So it is valid for clinical visits involving postpartum lactation failure, and it supports payment for qualifying services.

The code is current for FY2026, effective for dates of service October 1, 2025 through September 30, 2026.

According to the WHO ICD-10 browser, agalactia falls within the puerperium complications block. The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS) jointly maintain ICD-10-CM. Every year, they publish updates that decide which codes are valid for billing. As a result, the valid code set can shift from one fiscal year to the next.

Code hierarchy: Where O92.3 sits in ICD-10-CM

Understanding the code hierarchy helps coders navigate nearby codes and apply the right level of detail. Specifically, O92.3 sits four levels deep in the ICD-10-CM coding structure.

• Chapter XV (O00-O9A): Pregnancy, childbirth and the puerperium. This chapter covers all conditions arising in relation to pregnancy, delivery, or the postpartum period.
• Block O85-O92: Complications predominantly related to the puerperium. This block groups puerperal conditions including infection, venous complications, and lactation disorders.
• Category O92: Other disorders of breast and disorders of lactation associated with pregnancy and the puerperium. This category includes hypogalactia, suppressed lactation, galactorrhea, and agalactia, among others.
• O92.3: Agalactia. The specific billable code for complete absence or failure of milk secretion postpartum, limited to primary agalactia (milk never produced).

Coders working across Chapter XV diagnoses can cross-reference nearby codes, such as O68, to see how the structure affects code detail decisions. The full tabular list for Chapter XV is available via the CDC/NCHS ICD-10-CM web tool, which provides the official US code lookup by fiscal year.

What is agalactia? Clinical definition

Agalactia is the complete absence or failure of breast milk production following childbirth. It is distinct from hypogalactia (low milk supply) and suppressed lactation (a deliberate or drug-induced stop to an already-established supply).

ICD-10-CM draws a firm line between two clinical pictures that are easy to mix up in a chart note. In fact, the tabular list backs that line with an Excludes1 note under O92.3. Excludes1 means the excluded condition can never be coded together with, or in place of, O92.3:

• Primary agalactia (coded O92.3): Milk secretion never begins; no milk is ever produced. Usually related to hormonal insufficiency, mammary gland abnormality, or severe postpartum hemorrhage causing pituitary ischemia (Sheehan syndrome). This is the only presentation O92.3 covers.
• Secondary, elective, or therapeutic agalactia (coded O92.5, not O92.3): Milk production that ceases after an initial period of lactation, or is deliberately or medically suppressed. O92.3’s Excludes1 note specifically names “elective agalactia,” “secondary agalactia,” and “therapeutic agalactia” and routes all three to O92.5 (suppressed lactation).

In practice, this O92.3-vs-O92.5 distinction matters for accurate clinical records: if the note describes milk that was present and later stopped, or was suppressed on purpose or by a clinician, O92.5 is the correct code, not O92.3. Confirming which picture applies also supports medical necessity for lactation counseling encounters billed alongside either code.

Approximate synonyms and alternate terms for ICD-10 Code O92.3

The ICD-10-CM Alphabetic Index maps several clinical terms to O92.3. Using any of these in a chart note will lead a coder directly to this code during lookup, provided the encounter context confirms a postpartum setting.

• Failure of lactation
• Inability to breastfeed
• Primary agalactia
• Absence of milk secretion (postpartum)

Overall, these synonyms reflect how clinicians phrase the diagnosis in dictation or typed notes. For example, “failure of lactation” is the most common phrasing found in postpartum visit notes, and coders searching the AAPC Codify ICD-10-CM lookup will find O92.3 under this term.

“Inability to breastfeed” also maps here, though the underlying reason (supply failure vs infant latch issue) may affect which additional code, if any, accompanies O92.3.

Do not confuse this with “secondary agalactia,” “elective agalactia,” or “therapeutic agalactia.” O92.3’s Excludes1 note routes these terms to O92.5 (suppressed lactation) instead, since they describe milk that was established and then stopped or was deliberately suppressed.

Similarly, this kind of Alphabetic Index mapping is common across Chapter XV. A code like O75.0 maps from several distinct clinical phrasings the same way.

Related ICD-10 codes for puerperium lactation disorders

The O92 category contains several closely related codes. Notably, picking the wrong one is the most common coding error in postpartum lactation visits. The table below covers the codes coders most frequently encounter alongside O92.3.

Other Chapter XV categories follow the same table-driven structure. O70.4, for instance, groups delivery-related trauma the same way this table groups lactation disorders.

O92.3 vs O92.4 vs O92.5: Choosing the right lactation code

Three codes in the O92 category cover failure or change in milk production, and coders often ask which one applies. Ultimately, the clinical note is the deciding factor in every case.

Key rule: O92.3 applies only when milk production is completely absent, not merely reduced. If the chart note says “low supply” but does not state absence of milk, O92.4 is the correct code. When the note describes a patient who never produced milk despite postpartum time having passed, O92.3 applies.

This three-way distinction also matters when reviewing postpartum patient care management workflows, where coding accuracy directly affects which follow-up services qualify for payment.

How to use O92.3 in medical billing and documentation

O92.3 is a breastfeeding failure diagnosis code used at postpartum visits, lactation support visits, and any clinical visit where the provider notes agalactia as a diagnosis.

Because it belongs to Chapter XV (pregnancy and puerperium), it applies only to visits within the postpartum period, usually defined as up to six weeks after delivery. Clinical notes should establish the visit context clearly.

When to use O92.3

• Postpartum visit where the provider documents complete failure of milk production
• Lactation support encounter where agalactia is identified as the diagnosis
• Encounter where the provider evaluates underlying causes of lactation failure (e.g., Sheehan syndrome); O92.3 may be sequenced with or after the underlying cause code, depending on the encounter focus
• Telehealth or in-person lactation counseling with documented agalactia diagnosis

Coding tips and common documentation pitfalls

Several charting patterns cause coders to select the wrong code or miss a secondary code opportunity. EHR integration helps practices capture the structured data needed to support accurate coding at the point of encounter.

• Agalactia vs hypogalactia confusion: The most frequent error. “Low supply” does not mean absence. If the note uses vague language, query the provider before assigning O92.3 over O92.4.
• O92.3 vs O92.5 confusion: Confirm the chart note describes milk that was NEVER produced (primary agalactia → O92.3) rather than milk that started and then stopped, or was intentionally/medically suppressed (secondary, elective, or therapeutic agalactia → O92.5). O92.3 carries an Excludes1 note for these three terms, so the two codes can never be reported together for the same diagnosis.
• Encounter code pairing: When the visit is primarily a breastfeeding support encounter, consider whether Z39.1 (encounter for care and examination of lactating mother) applies as a companion code. Sequencing depends on the principal diagnosis for the visit.
• Underlying cause coding: If agalactia results from a documented underlying condition (such as a pituitary disorder), that condition may warrant an extra code. The ICD-10-CM Official Guidelines for Coding and Reporting govern sequencing in these cases.
• Payer-specific requirements: Some payers require documentation of treatment plan or referral for lactation services when billing O92.3. Check payer LCD policies before submission. Pabau’s claims management software supports attaching ICD-10-CM codes to claims and flagging missing documentation before submission.

How practice management software supports accurate lactation disorder coding

Most coders look up O92.3, confirm it is billable, and then switch to a separate system to attach it to the claim. That context switch is where errors happen: the code is correct, but the visit notes, supporting diagnosis, or sequencing detail get lost in translation.

By contrast, practice management platforms with built-in ICD-10-CM code lookup remove the switch. Clinicians record the visit, the system surfaces the right code, and the claim is built from the same record without re-keying.

For OB/GYN and postpartum practices, this matters because puerperium encounters often involve multiple codes that must be sequenced correctly. A standalone lookup tool cannot enforce sequencing logic; an integrated platform can prompt for it.

Pabau’s OB/GYN EMR software supports structured clinical records and postpartum documentation workflows. Providers can use digital intake forms to capture lactation history at the point of the encounter, creating the record trail that supports accurate O92.3 coding.

Likewise, good nursing documentation reinforces the same checkpoints that matter most for puerperium coding accuracy.

Practices that use structured clinical records in Pabau can template the postpartum note to include fields for agalactia presentation (primary, coded O92.3, versus secondary, elective, or therapeutic, coded O92.5), onset timing, and any underlying diagnoses.

That structure feeds directly into the coding and HIPAA compliance for billing requirements without extra manual work. As a result, you get fewer queries to providers, fewer coding errors, and fewer claim rejections on postpartum lactation visits.

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Conclusion

Postpartum lactation coding is a narrow field where one wrong code choice between O92.3, O92.4, and O92.5 changes the claim outcome. Ultimately, the distinction hinges on documentation detail, not just the clinical situation.

Pabau’s structured postpartum forms and built-in claims management tools help OB/GYN and lactation-focused practices capture the right records at the point of care, so coders have what they need to assign ICD-10 Code O92.3 correctly the first time. Fertility and reproductive health practices face the same record-keeping demands; book a demo and see how fertility clinic software supports them.

Continue your research

Coding a related postpartum complication? ICD-10 Code O90.89 covers postpartum subinvolution of the uterus, another puerperium diagnosis coders frequently pair with lactation-related visits.

Documenting trauma from delivery? ICD-10 Code O71.9 is the billable code for unspecified obstetric trauma occurring during labor and delivery.

Coding a device-related obstetric encounter? ICD-10 Code Y76.8 covers miscellaneous obstetric and gynecological devices associated with adverse incidents.

Frequently Asked Questions

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