Is O86.04 a billable ICD-10-CM code?

Yes. O86.04 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does O86.04 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 O86.04?

O86.04 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above O86.04 (O86.0) and apply to it just the same.

O86.04

O86.04 — Sepsis following an obstetrical procedure

Billable / specific codeICD-10-CM

O86.04 is a billable, specific ICD-10-CM code for sepsis following an obstetrical procedure. It is valid for submission on a claim.

Use additional code

Add a secondary code to capture the detail described below.

code to identify the sepsis

Excludes1 inherited from the categories above O86.04

These are not written on O86.04, but they bind it: a note on a category applies to every code beneath it. Billing O86.04 with anything listed here is a denial.

Written on O86.0 — Infection of obstetric surgical wound

complications of procedures, not elsewhere classified (T81.4-)
postprocedural fever NOS (R50.82)
postprocedural retroperitoneal abscess (K68.11)

Excludes2 inherited from the categories above O86.04

Also inherited, and the opposite of Excludes1: these conditions are not part of O86.04, but a patient can have both, so you may code both.

Written on O86 — Other puerperal infections

infection during labor (O75.3)
obstetrical tetanus (A34)

Other codes that can never be billed with O86.04

These codes carry an Excludes1 note pointing at O86.04. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading O86.04 alone.

N71Inflammatory disease of uterus, except cervix

Risk adjustment

O86.04 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

O86.04 is named in 1 Medicare coverage policy — 1 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

How O86.04 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 O86.04.

Sepsis›following›obstetrical procedure

Code history

O86.04 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share O86.0. If O86.04 is not quite right, the correct code is usually one of these.

Questions about O86.04

Is O86.04 a billable ICD-10-CM code?: Yes. O86.04 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does O86.04 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 O86.04?: O86.04 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above O86.04 (O86.0) and apply to it just the same.