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O86.04 ICD-10-CM Code: Sepsis following an obstetrical procedure

Compare with another code for O86.04Check this code on a claim

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

Coding at a Glance

Tabular directives
3 Excludes1 · 4 Excludes2 · 2 use-additional codes

Billable · FY2027A valid, specific ICD-10-CM code, reportable for dates of service in FY2027.

What you need to know

Source: CMS/NCHS Official ICD-10-CM tabular notes, quoted. From the CMS/NCHS tabular list for the release in force. A note the category or block publishes applies to this code too, and is marked with where it comes from.

Use additional codeReport with this code when documented
  • Use additional code to identify the sepsis
  • Use additional code (B95-B97), to identify infectious agent (from O86)
Excludes1from O86.0Not reported with this code unless documented as unrelated
  • complications of procedures, not elsewhere classified (T81.4-)
  • postprocedural fever NOS (R50.82)
  • postprocedural retroperitoneal abscess (K68.11)
Excludes2Not included here; may be reported together
  • infection during labor (O75.3) (from O86)
  • obstetrical tetanus (A34) (from O85-O92)
  • mental and behavioral disorders associated with the puerperium (F53.-) (from O85-O92)
  • puerperal osteomalacia (M83.0) (from O85-O92)

Where it sits Source: CMS/NCHS

Under:Chapter 15: Pregnancy, Childbirth and the PuerperiumO85-O92 Complications predominantly related to the puerperiumO86 Other puerperal infectionsO86.0 Infection of obstetric surgical wound

Most relevant related codes MedCoder-derived

Read off the official notes above and this code’s own position in the tabular list. Which to report is a documentation question; Compare shows the two side by side.

CompareCheck ClaimView Related 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 v44, 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 O86.04 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on O86.04 itself; “inherited from” names the category or block whose note applies here.

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).

Source: inherited from O86.0

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 to identify the sepsis
  • Use additional code (B95-B97), to identify infectious agent inherited from O86

Coder workflow for O86.04

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

Before you code O86.04

  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 O86.04. 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 O86.04’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.

    ReviewT81.4, R50.82, K68.11

Consider O86.04. 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 O86.04(3 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with O86.04: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareT81.4, R50.82, K68.11

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

  • Excludes2 — not part of O86.04(4 notes)

    Coding workflow: The conditions named in this note are not included in O86.04. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareO75.3, A34, F53, M83.0

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

  • Use Additional Code — after identifying O86.04(2 notes)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with O86.04 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    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 O86.04 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).

ReviewT81.4, R50.82, K68.11

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

Coding question: Is a second code reported with O86.04?

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).

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.

Don’t confuse O86.04 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of O86.04 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • T81.4— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of complications of procedures, not elsewhere classified moves the case to T81.4; the two are not reported together unless documented as unrelated.

    Full comparison: O86.04 vs T81.4 →

  • R50.82— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of postprocedural fever NOS moves the case to R50.82; the two are not reported together unless documented as unrelated.

    Full comparison: O86.04 vs R50.82 →

  • K68.11— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of postprocedural retroperitoneal abscess moves the case to K68.11; the two are not reported together unless documented as unrelated.

    Full comparison: O86.04 vs K68.11 →

  • O86.00— Specificity relationship (Review)

    Overlapping diagnoses in the same category.

    Overlapping codes in the same category — the documentation decides which is the more specific fit.

    What moves you there: A record that documents no more than “Infection of obstetric surgical wound, unspecified” takes O86.00; specificity in the record moves it back here.

    Full comparison: O86.04 vs O86.00 →

  • O75.3— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of infection during labor adds O75.3; it is not part of this code and both may be reported when both are documented.

    Full comparison: O86.04 vs O75.3 →

  • A34— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of obstetrical tetanus adds A34; it is not part of this code and both may be reported when both are documented.

    Full comparison: O86.04 vs A34 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Coding context

Guidelines, coding notes, decision aids, relationships (with MS-DRG and CCSR classification), hierarchy, HCC, coverage and the context map: what a coder reaches for after the core. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Code Overview

Sepsis following an obstetrical procedure is a billable ICD-10-CM diagnosis code (O86.04).

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

Official Coding 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 1: Certain Infectious and Parasitic Diseases (A00-B99), U07.1, U09.9 a. Human Immunodeficiency Virus (HIV) Infections 1) Code only confirmed cases

(b) Sepsis due to a postprocedural infection For sepsis following a postprocedural wound (surgical site) infection, a code from T81.41 to T81.43, Infection following a procedure, T81.49, Infection following a procedure, other surgical site, or a code from O86.00 to O86.03, Infection of obstetric surgical wound, or code O86.09, Infection of obstetric surgical wound, other surgical site, that identifies the site of the infection should be sequenced first, if known. Assign an additional code for sepsis following a procedure (T81.44) or sepsis following an obstetrical procedure (O86.04). Use an additional code to identify the infectious agent. If the patient has severe sepsis, the appropriate code from subcategory R65.2 should also be assigned with the additional code(s) for any acute organ dysfunction.

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. 4 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 (FY2027). 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-derived relationships — computed from published CMS and AHRQ datasets

Other codes that name O86.04 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 9 Excludes1 notes: N70 — Salpingitis and oophoritis (via O86.-), N70-N77 — Inflammatory diseases of female pelvic organs (N70-N77) (via O86.-), N71 — Inflammatory disease of uterus, except cervix (via O86.-), N72 — Inflammatory disease of cervix uteri (via O86.-), N73 — Other female pelvic inflammatory diseases (via O86.-), N74 — Female pelvic inflammatory disorders in diseases classified elsewhere (via O86.-), N75 — Diseases of Bartholin's gland (via O86.-), N76 — Other inflammation of vagina and vulva (via O86.-), N77 — Vulvovaginal ulceration and inflammation in diseases classified elsewhere (via O86.-).

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

Referenced by 4 Excludes2 notes across 2 chapters: O75 — Other complications of labor and delivery, not elsewhere classified (via O86.-), O75.4 — Other complications of obstetric surgery and procedures (via O86.0.-), O98 — Maternal infectious and parasitic diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperium (via O86.-), T81.4 — Infection following a procedure (via O86.0.-).

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

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 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):PRG023 — Complications specified during childbirth (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.

O35.7XX3 — 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, O85 — Puerperal sepsis, 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, O99.13 — Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism complicating the puerperium, +204 more

Same clinical category (CCSR)

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

O75.9 — Complication of labor and delivery, unspecified, O76 — Abnormality in fetal heart rate and rhythm complicating labor and delivery, O77.0 — Labor and delivery complicated by meconium in amniotic fluid, O82 — Encounter for cesarean delivery without indication, O85 — Puerperal sepsis, O86.0 — Infection of obstetric surgical wound, O86.00 — Infection of obstetric surgical wound, unspecified, O86.01 — Infection of obstetric surgical wound, superficial incisional site, O86.02 — Infection of obstetric surgical wound, deep incisional site, O86.03 — Infection of obstetric surgical wound, organ and space site, O86.09 — Infection of obstetric surgical wound, other surgical site, O88.02 — Air embolism in childbirth, O88.12 — Amniotic fluid embolism in childbirth, O88.22 — Thromboembolism in childbirth, O88.32 — Pyemic and septic embolism in childbirth, O88.82 — Other embolism in childbirth, O98.02 — Tuberculosis complicating childbirth, O98.12 — Syphilis complicating childbirth, O98.22 — Gonorrhea complicating childbirth, O98.32 — Other infections with a predominantly sexual mode of transmission complicating childbirth, +141 more

Same Index main term, other category

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

A42.7 — Actinomycotic sepsis (actinomycotic), A54.86 — Gonococcal sepsis (gonococcal), B00.7 — Disseminated herpesviral disease (herpesviral), B37.7 — Candidal sepsis (candidal), J95.02 — Infection of tracheostomy stoma (tracheostomy stoma), K65.1 — Peritoneal abscess (intra-abdominal), O08.0 — Genital tract and pelvic infection following ectopic and molar pregnancy (following, abortion), O08.82 — Sepsis following ectopic and molar pregnancy (with, ectopic or molar pregnancy), O75.3 — Other infection during labor (during labor), O85 — Puerperal sepsis (puerperal, postpartum, childbirth), P36.0 — Sepsis of newborn due to streptococcus, group B (newborn, due to, Streptococcus, group B), P36.10 — Sepsis of newborn due to unspecified streptococci (newborn, due to, Streptococcus), P36.19 — Sepsis of newborn due to other streptococci (newborn, due to, Streptococcus, specified NEC), P36.2 — Sepsis of newborn due to Staphylococcus aureus (newborn, due to, Staphylococcus, aureus), P36.30 — Sepsis of newborn due to unspecified staphylococci (newborn, due to, Staphylococcus), P36.39 — Sepsis of newborn due to other staphylococci (newborn, due to, Staphylococcus, specified NEC), P36.4 — Sepsis of newborn due to Escherichia coli (newborn, due to, Escherichia coli), P36.5 — Sepsis of newborn due to anaerobes (newborn, due to, anaerobes NEC), P36.8 — Other bacterial sepsis of newborn (newborn, specified NEC), P36.9 — Bacterial sepsis of newborn, unspecified (newborn), +58 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Partial Thromboplastin Time (PTT) Test, Prothrombin Time Test and INR (PT/INR)

Contextual Map

Every relationship of O86.04 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 O86.04 with these 12 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes (9)

Referenced by Excludes2 notes

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 · FY2027

Index entries

  • Sepsis (generalized) (unspecified organism), following, obstetrical procedure[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027

Nearest codes (21)

Change history

Reference

Index terms and tables, published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

Indexed Clinical Terms (1)

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.

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 FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2027), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 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 — v44 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-derived 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 editorial 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.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 28, 2026 · All releases and sources

Labels on this page: Official source data · MedCoder-derived relationship · MedCoder editorial explanation. How to read the labels · All data sources and release dates · CMS coding rules

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. "O86.04 — Sepsis following an obstetrical procedure." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/o86.04-sepsis-following-an-obstetrical-procedure

Change history

  • FY2019 — October 1, 2018
    Added to the code set
    Sepsis following an obstetrical procedure
    FY2019 changes

Nearest Codes in This Family

Official ICD-10-CM classifications closest to O86.04 in its code family, with their registry titles.

View all codes in the O86 family