O85 — Puerperal sepsis
O85 is a billable, specific ICD-10-CM code for puerperal sepsis. It is valid for submission on a claim.
Excludes1 — 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
These codes carry an Excludes1 note pointing at O85. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading O85 alone.
Risk adjustment
O85 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
O85 is named in 2 Medicare coverage policies — 2 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A56421Billing and Coding: CT of the Abdomen and Pelvis
- A57204Billing and Coding: MRI and CT Scans of the Head and Neck
How O85 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to O85.
- 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
Questions about O85
- Is O85 a billable ICD-10-CM code?
- Yes. O85 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does O85 sit in the tabular list?
- Pregnancy, childbirth and the puerperium (O00-O9A), in the block Complications predominantly related to the puerperium (O85-O92).
- What cannot be coded together with O85?
- O85 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.