O85: Puerperal sepsis
O85 is a billable, specific ICD-10-CM code for puerperal sepsis. It is valid for submission on a claim.
Check O85 with the rest of the claim: free scrubberExcludes1: never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
Excludes2: not included here, but may coexist
The excluded condition is not part of this code, but a patient can have both. You may code both.
Use additional code
Add a secondary code to capture the detail described below.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Postpartum sepsis
- Puerperal peritonitis
- Puerperal pyemia
Other codes that can never be billed with O85
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Medicare coverage
O85 is named in 2 Medicare coverage policies: 2 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A56421Billing and Coding: CT of the Abdomen and Pelvis
- A57204Billing and Coding: MRI and CT Scans of the Head and Neck
Alphabetic index entries that lead here
- Pelviperitonitis›puerperal
- Peritonitis›puerperal, postpartum, childbirth
- Puerperal, puerperium›metroperitonitis
- Puerperal, puerperium›parametritis
- Puerperal, puerperium›pelviperitonitis
- Puerperal, puerperium›peritoneal infection
- Puerperal, puerperium›peritonitis(pelvic)
- Puerperal, puerperium›pyemia
- Puerperal, puerperium›pyohemia
- Puerperal, puerperium›salpingoperitonitis
- Puerperal, puerperium›sepsis(pelvic)
- Pyemia, pyemic›puerperal, postpartum, childbirth
Code history
Unchanged in every release from FY2024 to FY2027.