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O85 ICD-10-CM Code: Puerperal sepsis

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
3 inclusion terms · 3 Excludes1 · 6 Excludes2 · 2 use-additional codes

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 769 — POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES (MDC 14)
  • MS-DRG 776 — POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES (MDC 14)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for O85 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on O85 itself; “inherited from” names the category or block whose note applies here.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Postpartum sepsis
  • Puerperal peritonitis
  • Puerperal pyemia

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code (B95-B97), to identify infectious agent
  • Use additional code (R65.2-) to identify severe sepsis, if applicable

Coder workflow for O85

MedCoder structured workflow — derived from this code’s own official record

Before you code O85

  1. Confirm the condition is documented as complicating the pregnancy, childbirth, or the puerperium, and check the trimester where the code carries one and the fetus character where the category requires it. Chapter 15 codes belong on the maternal record only and take sequencing priority over codes from other chapters. It is the provider’s responsibility to state that a condition is not affecting the pregnancy; the trimester is assigned from the documentation (Guidelines I.C.15.a, I.C.15.a.1, I.C.15.a.3).

    Guide: How to choose an ICD-10-CM code →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with O85. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in O85’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewO86.4, O88.3, O86.81

Consider O85. Then work the Use Additional Code note, and confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Trimester
Assigned from the documented trimester at the encounter, or the trimester in which the condition developed for inpatient stays (Guidelines I.C.15.a.3).
The conditions the Use Additional Code note names
Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.

Official instructions as workflow

  • Excludes1 — check before selecting O85(3 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with O85: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareO86.4, O88.3, O86.81

    See the official tabular notes · Guidelines I.A.12.a

  • Excludes2 — not part of O85(6 notes)

    Coding workflow: The conditions named in this note are not included in O85. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareO86.1, O75.3, O86.2, F53, A34, M83.0

    See the official tabular notes · Guidelines I.A.12.b

  • Use Additional Code — after identifying O85(2 notes)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with O85 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    ReviewR65.2

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition O85 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewO86.4, O88.3, O86.81

Documentation: A condition the Use Additional Code note names is documented.

Coding question: Is a second code reported with O85?

Path: Review the Use Additional Code note and the code it names.

Reason: The additional code is reported when the record documents the condition; a conditional instruction applies only when its condition is met (Guidelines I.A.13).

ReviewR65.2

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Puerperal sepsis is a billable ICD-10-CM diagnosis code (O85).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (21)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00-O9A)

k. Puerperal sepsis Code O85, Puerperal sepsis, should be assigned with a secondary code to identify the causal organism (e.g., for a bacterial infection, assign a code from category B95-B96, Bacterial infections in conditions classified elsewhere). A code from category A40, Streptococcal sepsis, or A41, Other sepsis, should not be used for puerperal sepsis. If applicable, use additional codes to identify severe sepsis (R65.2-) and any associated acute organ dysfunction.

Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00-O9A)

Code O85 should not be assigned for sepsis following an obstetrical procedure (See Section I.C.1.d.5.b., Sepsis due to a postprocedural infection).

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. 2 Use Additional Code instructions — report the named additional code(s) when the documentation supports them. See the Use Additional Code notes
  2. 3 Excludes1 entries — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
  3. 6 Excludes2 entries — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

  • Age-restricted: the Medicare Code Editor lists this as a maternity (age 9-64) diagnosis; other ages are presumed incorrect.
  • MCC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name O85 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 12 Excludes1 notes across 3 chapters: A40 — Streptococcal sepsis, A41 — Other sepsis, K65 — Peritonitis, N70 — Salpingitis and oophoritis, N70-N77 — Inflammatory diseases of female pelvic organs (N70-N77), N71 — Inflammatory disease of uterus, except cervix, N72 — Inflammatory disease of cervix uteri, N73 — Other female pelvic inflammatory diseases, N74 — Female pelvic inflammatory disorders in diseases classified elsewhere, N75 — Diseases of Bartholin's gland, N76 — Other inflammation of vagina and vulva, N77 — Vulvovaginal ulceration and inflammation in diseases classified elsewhere.

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 2 Excludes2 notes: O75 — Other complications of labor and delivery, not elsewhere classified, O98 — Maternal infectious and parasitic diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium.

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 1 Code First instruction: R65.2 — Severe sepsis.

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: MCC — Major Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 225 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 2 MS-DRGs: DRG 769 (MDC 14), DRG 776 (MDC 14).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):PRG027 — Complications specified during the puerperium (default); INF002 — Septicemia.

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as MCC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

O35.7XX2 — Maternal care for (suspected) damage to fetus by other medical procedures, fetus 2, O35.7XX3 — Maternal care for (suspected) damage to fetus by other medical procedures, fetus 3, O35.7XX4 — Maternal care for (suspected) damage to fetus by other medical procedures, fetus 4, O35.7XX5 — Maternal care for (suspected) damage to fetus by other medical procedures, fetus 5, O35.7XX9 — Maternal care for (suspected) damage to fetus by other medical procedures, other fetus, O75.4 — Other complications of obstetric surgery and procedures, O75.81 — Maternal exhaustion complicating labor and delivery, O75.89 — Other specified complications of labor and delivery, O75.9 — Complication of labor and delivery, unspecified, O80 — Encounter for full-term uncomplicated delivery, O86.04 — Sepsis following an obstetrical procedure, O86.12 — Endometritis following delivery, O86.81 — Puerperal septic thrombophlebitis, O86.89 — Other specified puerperal infections, O90.89 — Other complications of the puerperium, not elsewhere classified, O99.111 — Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism complicating pregnancy, first trimester, O99.112 — Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism complicating pregnancy, second trimester, O99.113 — Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism complicating pregnancy, third trimester, O99.119 — Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism complicating pregnancy, unspecified trimester, O99.12 — Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism complicating childbirth, +204 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Complications specified during the puerperium, Septicemia).

O24.83 — Other pre-existing diabetes mellitus in the puerperium, O24.93 — Unspecified diabetes mellitus in the puerperium, O25.3 — Malnutrition in the puerperium, O26.63 — Liver and biliary tract disorders in the puerperium, O26.73 — Subluxation of symphysis (pubis) in the puerperium, O71.2 — Postpartum inversion of uterus, O72.0 — Third-stage hemorrhage, O72.1 — Other immediate postpartum hemorrhage, O72.2 — Delayed and secondary postpartum hemorrhage, O72.3 — Postpartum coagulation defects, O86.04 — Sepsis following an obstetrical procedure, O86.11 — Cervicitis following delivery, O86.12 — Endometritis following delivery, O86.13 — Vaginitis following delivery, O86.19 — Other infection of genital tract following delivery, O86.20 — Urinary tract infection following delivery, unspecified, O86.21 — Infection of kidney following delivery, O86.22 — Infection of bladder following delivery, O86.29 — Other urinary tract infection following delivery, O86.4 — Pyrexia of unknown origin following delivery, +163 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Abscess”, “Sepsis”, “Puerperal, puerperium”; these codes share that main term but sit in a different category of the Tabular List.

O24.83 — Other pre-existing diabetes mellitus in the puerperium (diabetes, pre-existing, specified NEC), O24.93 — Unspecified diabetes mellitus in the puerperium (diabetes), O25.3 — Malnutrition in the puerperium (malnutrition), O26.63 — Liver and biliary tract disorders in the puerperium (necrosis, liver), O26.73 — Subluxation of symphysis (pubis) in the puerperium (subluxation of symphysis), O72.0 — Third-stage hemorrhage (retention, placenta), O72.1 — Other immediate postpartum hemorrhage (hemorrhage), O72.2 — Delayed and secondary postpartum hemorrhage (hemorrhage, uterine, delayed), O72.3 — Postpartum coagulation defects (blood dyscrasia), O75.3 — Other infection during labor (during labor), O86.01 — Infection of obstetric surgical wound, superficial incisional site (stitch, following an obstetrical procedure), O86.02 — Infection of obstetric surgical wound, deep incisional site (intramuscular, following procedure, obstetrical), O86.03 — Infection of obstetric surgical wound, organ and space site (subphrenic, following an obstetrical procedure), O86.04 — Sepsis following an obstetrical procedure (following, obstetrical procedure), O86.09 — Infection of obstetric surgical wound, other surgical site (infection, genital tract NEC, obstetric surgical wound), O86.11 — Cervicitis following delivery (cervicitis), O86.12 — Endometritis following delivery (pyometra), O86.13 — Vaginitis following delivery (vaginitis), O86.19 — Other infection of genital tract following delivery (vulvitis), O86.20 — Urinary tract infection following delivery, unspecified (infection, urinary NEC), +356 more

Contextual Map

Every relationship of O85 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run O85 with these 23 related codes in Claim Check

Hierarchy

Excludes1

Excludes2

Use Additional Code

Referenced by Excludes1 notes (12)

Referenced by Excludes2 notes

Referenced by Code First instructions

  • R65.2 — Severe sepsis[Code First]: “puerperal sepsis (O85)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • MDC 14 — Pregnancy, Childbirth and the Puerperium[MDC crossing]: “Pregnancy, Childbirth and the Puerperium — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 94 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries (21)

  • Abscess (connective tissue) (embolic) (fistulous) (infective) (metastatic) (multiple) (pernicious) (pyogenic) (septic), peritoneum, peritoneal (perforated) (ruptured), puerperal, postpartum, childbirth[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Infection, infected, infective (opportunistic), major, puerperal, postpartum, childbirth[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Infection, infected, infective (opportunistic), puerperal, major or generalized[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Pelviperitonitis, puerperal[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Peritonitis (adhesive) (bacterial) (fibrinous) (hemorrhagic) (idiopathic) (localized) (perforative) (primary) (with adhesions) (with effusion), puerperal, postpartum, childbirth[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Puerperal, puerperium (complicated by, complications), abscess, peritoneum[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Puerperal, puerperium (complicated by, complications), fever (of unknown origin), septic[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Puerperal, puerperium (complicated by, complications), infection, generalized[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • and 13 more

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "O85 — Puerperal sepsis." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/o85-puerperal-sepsis

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Puerperal sepsis

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.