2020 ICD-10-CM Diagnosis Code O86.04

Sepsis following an obstetrical procedure

    2019 - New Code 2020 Billable/Specific Code Maternity Dx (12-55 years)
  • O86.04 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
  • The 2020 edition of ICD-10-CM O86.04 became effective on October 1, 2019.
  • This is the American ICD-10-CM version of O86.04 - other international versions of ICD-10 O86.04 may differ.
ICD-10-CM Coding Rules
  • O86.04 is applicable to maternity patients aged 12 - 55 years inclusive.
Use Additional
Use Additional Help
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation. In most cases the manifestation codes will have in the code title, "in diseases classified elsewhere." Codes with this title are a component of the etiology/manifestation convention. The code title indicates that it is a manifestation code. "In diseases classified elsewhere" codes are never permitted to be used as first listed or principle diagnosis codes. They must be used in conjunction with an underlying condition code and they must be listed following the underlying condition.
  • code to identify the sepsis
The following code(s) above O86.04 contain annotation back-references
Annotation Back-References
In this context, annotation back-references refer to codes that contain:
  • Applicable To annotations, or
  • Code Also annotations, or
  • Code First annotations, or
  • Excludes1 annotations, or
  • Excludes2 annotations, or
  • Includes annotations, or
  • Note annotations, or
  • Use Additional annotations
that may be applicable to O86.04:
  • O00-O9A
    2020 ICD-10-CM Range O00-O9A

    Pregnancy, childbirth and the puerperium

    Note
    • 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
    Type 1 Excludes
    • supervision of normal pregnancy (Z34.-)
    Type 2 Excludes
    • mental and behavioral disorders associated with the puerperium (F53.-)
    • obstetrical tetanus (A34)
    • postpartum necrosis of pituitary gland (E23.0)
    • puerperal osteomalacia (M83.0)
    Use Additional
    • code from category Z3A, Weeks of gestation, to identify the specific week of the pregnancy, if known.
    Pregnancy, childbirth and the puerperium
  • O85-O92
    2020 ICD-10-CM Range O85-O92

    Complications predominantly related to the puerperium

    Type 2 Excludes
    • mental and behavioral disorders associated with the puerperium (F53.-)
    • obstetrical tetanus (A34)
    • puerperal osteomalacia (M83.0)
    Complications predominantly related to the puerperium
  • O86
    ICD-10-CM Diagnosis Code O86

    Other puerperal infections

      2016 2017 2018 2019 2020 Non-Billable/Non-Specific Code
    Type 2 Excludes
    • infection during labor (O75.3)
    • obstetrical tetanus (A34)
    Use Additional
    • code (B95-B97), to identify infectious agent
    Other puerperal infections
  • O86.0
    ICD-10-CM Diagnosis Code O86.0

    Infection of obstetric surgical wound

      2016 2017 2018 2019 - Converted to Parent Code 2020 Non-Billable/Non-Specific Code
    Applicable To
    • Infected cesarean delivery wound following delivery
    • Infected perineal repair following delivery
    Type 1 Excludes
    • complications of procedures, not elsewhere classified (T81.4-)
    • postprocedural fever NOS (R50.82)
    • postprocedural retroperitoneal abscess (K68.11)
    Infection of obstetric surgical wound
ICD-10-CM O86.04 is grouped within Diagnostic Related Group(s) (MS-DRG v37.0):
  • 769 Postpartum and post abortion diagnoses with o.r. Procedure
  • 776 Postpartum and post abortion diagnoses without o.r. Procedure
Code History
  • 2019 (effective 10/1/2018): New code
  • 2020 (effective 10/1/2019): No change

Diagnosis Index entries containing back-references to O86.04:
  • Sepsis (generalized) (unspecified organism) A41.9
    ICD-10-CM Diagnosis Code A41.9

    Sepsis, unspecified organism

      2016 2017 2018 2019 2020 Billable/Specific Code
    Applicable To
    • Septicemia NOS

ICD-10-CM Codes Adjacent To O86.04
O77.9 Labor and delivery complicated by fetal stress, unspecified
O80 Encounter for full-term uncomplicated delivery
O82 Encounter for cesarean delivery without indication
O85 Puerperal sepsis
O86 Other puerperal infections
O86.0 Infection of obstetric surgical wound
O86.00 …… unspecified
O86.01 …… superficial incisional site
O86.02 …… deep incisional site
O86.03 …… organ and space site
O86.04 Sepsis following an obstetrical procedure
O86.09 …… other surgical site
O86.1 Other infection of genital tract following delivery
O86.11 Cervicitis following delivery
O86.12 Endometritis following delivery
O86.13 Vaginitis following delivery
O86.19 Other infection of genital tract following delivery
O86.2 Urinary tract infection following delivery
O86.20 …… unspecified
O86.21 Infection of kidney following delivery
O86.22 Infection of bladder following delivery

Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes.