O90.49 ICD-10-CM Code: Other postpartum acute kidney failure

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for O90.49 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 O90.49 itself; “inherited from” names the category or block whose note applies here.

Coder workflow for O90.49

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

Before you code O90.49

1. “Other” (NEC) means the condition is specified in the record but no dedicated code captures it. Confirm the documented form is not one a sibling code names before settling on O90.49; if the record states no specifics at all, the unspecified sibling applies instead. “Other” codes are for documented conditions the classification gives no specific code; “unspecified” codes are for records lacking the detail (Guidelines I.A.9.a, I.A.9.b).

   ReviewO90.41

   See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

2. 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 →

3. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with O90.49. 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 O90.49’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.

   ReviewR34

Consider O90.49. Then 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).

Acuity

Acute or chronic as documented; when both are documented and separate codes exist, both are reported with the acute code first (Guidelines I.B.8).

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).

Any detail beyond this code’s title

What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

• Excludes1 — check before selecting O90.49(1 note)

  Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with O90.49: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

  CompareR34

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

• Excludes2 — not part of O90.49(3 notes)

  Coding workflow: The conditions named in this note are not included in O90.49. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

  CompareF53, A34, M83.0

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

Coding decision scenarios

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

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.

Indexed Clinical Terms (7)

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.

• Anuria, puerperal
• Failure, failed, renal, following, labor and delivery (acute)
• Oliguria, puerperal
• Puerperal, puerperium (complicated by, complications), failure, renal, acute
• Puerperal, puerperium (complicated by, complications), necrosis, liver (acute) (subacute) (conditions in subcategory K72.0), with renal failure
• Puerperal, puerperium (complicated by, complications), renal, failure
• Puerperal, puerperium (complicated by, complications), uremia (due to renal failure)

Don’t confuse O90.49 with…

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

The codes most likely to be picked instead of O90.49 — 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.

• R34— 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 anuria and oliguria moves the case to R34; the two are not reported together unless documented as unrelated.

  Full comparison: O90.49 vs R34 →

• F53— 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 mental and behavioral disorders associated with the puerperium adds F53; it is not part of this code and both may be reported when both are documented.

  Full comparison: O90.49 vs F53 →

• 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: O90.49 vs A34 →

• M83.0— 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 puerperal osteomalacia adds M83.0; it is not part of this code and both may be reported when both are documented.

  Full comparison: O90.49 vs M83.0 →

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.

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 O90.49 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 1 Excludes1 note: R34 — Anuria and oliguria.

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

Referenced by 1 Excludes2 note: O99.8 — Other specified diseases and conditions complicating pregnancy, childbirth and the puerperium.

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

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 222 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); GEN002 — Acute and unspecified renal failure.

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, O90.41 — Hepatorenal syndrome following labor and delivery, 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, O99.210 — Obesity complicating pregnancy, unspecified trimester, O99.211 — Obesity complicating pregnancy, first trimester, O99.212 — Obesity complicating pregnancy, second trimester, +201 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Complications specified during the puerperium, Acute and unspecified renal failure).

O89.4 — Spinal and epidural anesthesia-induced headache during the puerperium, O89.5 — Other complications of spinal and epidural anesthesia during the puerperium, O89.6 — Failed or difficult intubation for anesthesia during the puerperium, O89.8 — Other complications of anesthesia during the puerperium, O89.9 — Complication of anesthesia during the puerperium, unspecified, O90.0 — Disruption of cesarean delivery wound, O90.1 — Disruption of perineal obstetric wound, O90.2 — Hematoma of obstetric wound, O90.4 — Postpartum acute kidney failure, O90.41 — Hepatorenal syndrome following labor and delivery, O90.5 — Postpartum thyroiditis, O90.6 — Postpartum mood disturbance, O90.81 — Anemia of the puerperium, O90.89 — Other complications of the puerperium, not elsewhere classified, O90.9 — Complication of the puerperium, unspecified, O91.02 — Infection of nipple associated with the puerperium, O91.03 — Infection of nipple associated with lactation, O91.12 — Abscess of breast associated with the puerperium, O91.13 — Abscess of breast associated with lactation, O91.22 — Nonpurulent mastitis associated with the puerperium, +122 more

Same Index main term, other category

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

O86.89 — Other specified puerperal infections (lymphangitis), O87.0 — Superficial thrombophlebitis in the puerperium (phlebitis), O87.1 — Deep phlebothrombosis in the puerperium (milk leg), O87.2 — Hemorrhoids in the puerperium (hemorrhoids), O87.4 — Varicose veins of lower extremity in the puerperium (varicose veins), O87.8 — Other venous complications in the puerperium (varicose veins, vulva or perineum), O87.9 — Venous complication in the puerperium, unspecified (venous), O89.1 — Cardiac complications of anesthesia during the puerperium (heart, complicating, anesthesiaor other sedation, postpartum, puerperal), O89.6 — Failed or difficult intubation for anesthesia during the puerperium (intubation during anesthesia, postpartum, puerperal), O89.8 — Other complications of anesthesia during the puerperium (anesthetic death), O91.02 — Infection of nipple associated with the puerperium (thelitis), O91.03 — Infection of nipple associated with lactation (thelitis, associated with lactation), O91.12 — Abscess of breast associated with the puerperium (abscess, breast), O91.13 — Abscess of breast associated with lactation (abscess, breast, associated with lactation), O91.22 — Nonpurulent mastitis associated with the puerperium (mammitis), O91.23 — Nonpurulent mastitis associated with lactation (mastitis, associated with lactation), O92.02 — Retracted nipple associated with the puerperium (retracted nipple), O92.12 — Cracked nipple associated with the puerperium (fissure, nipple), O92.13 — Cracked nipple associated with lactation (fissure, nipple, associated with lactation), O92.29 — Other disorders of breast associated with pregnancy and the puerperium (induration breast), +220 more

Contextual Map

Every relationship of O90.49 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 O90.49 with these 2 related codes in Claim Check

Hierarchy

• O00-O9A — Chapter 15: Pregnancy, Childbirth and the Puerperium (O00-O9A) (O00-O9A)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• O85-O92 — Complications predominantly related to the puerperium[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Referenced by Excludes1 notes

• R34 — Anuria and oliguria[Excludes1]: “anuria and oliguria complicating the puerperium (O90.49)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Referenced by Excludes2 notes

• O99.8 — Other specified diseases and conditions complicating pregnancy, childbirth and the puerperium[Excludes2]: “postpartum acute kidney failure (O90.49)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

• PRG027 — Complications specified during the puerperium[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)
• GEN002 — Acute and unspecified renal failure[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

MS-DRG Grouper

• MCC — Major Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (MCC).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2026
• DRG 769 — POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES[MS-DRG]: “POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES (MDC 14)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 776 — POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES[MS-DRG]: “POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES (MDC 14)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

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

• Anuria, puerperal[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Failure, failed, renal, following, labor and delivery (acute)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Oliguria, puerperal[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Puerperal, puerperium (complicated by, complications), failure, renal, acute[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Puerperal, puerperium (complicated by, complications), necrosis, liver (acute) (subacute) (conditions in subcategory K72.0), with renal failure[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Puerperal, puerperium (complicated by, complications), renal, failure[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Puerperal, puerperium (complicated by, complications), uremia (due to renal failure)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (13)

• O90 — Complications of the puerperium, not elsewhere classified[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• O90.0 — Disruption of cesarean delivery wound[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• O90.1 — Disruption of perineal obstetric wound[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• O90.2 — Hematoma of obstetric wound[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• O90.3 — Peripartum cardiomyopathy[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• O90.4 — Postpartum acute kidney failure[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• O90.41 — Hepatorenal syndrome following labor and delivery[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• O90.5 — Postpartum thyroiditis[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• and 5 more

Change history

• FY2024 — Added to the code set[Change history]— CMS release files (code change ledger) · icd10cm-fy2024

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

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

Nearest Codes in This Family

Official ICD-10-CM classifications closest to O90.49 in its code family, with their registry titles.

• O90.1 — Disruption of perineal obstetric wound
• O90.2 — Hematoma of obstetric wound
• O90.3 — Peripartum cardiomyopathy
• O90.4 — Postpartum acute kidney failure
• O90.41 — Hepatorenal syndrome following labor and delivery
• O90.5 — Postpartum thyroiditis
• O90.6 — Postpartum mood disturbance
• O90.8 — Other complications of the puerperium, not elsewhere classified
• O90.81 — Anemia of the puerperium
• O90.89 — Other complications of the puerperium, not elsewhere classified

View all codes in the O90 family