ICD-10-CM Code O85

Valid for Submission

O85 is a billable code used to specify a medical diagnosis of puerperal sepsis. The code is valid for the year 2020 for the submission of HIPAA-covered transactions. The ICD-10-CM code O85 might also be used to specify conditions or terms like major puerperal infection, puerperal pelvic sepsis, puerperal peritonitis, puerperal peritonitis - delivered with postnatal complication, puerperal peritonitis with postnatal complication, puerperal sepsis, etc

The code O85 is applicable to female patients aged 12 through 55 years inclusive. It is clinically and virtually impossible to use this code on a non-female patient outside the stated age range.

Tabular List of Diseases and Injuries

The Tabular List of Diseases and Injuries is a list of ICD-10 codes, organized "head to toe" into chapters and sections with guidance for inclusions, exclusions, descriptions and more. The following references are applicable to the code O85:

Inclusion Terms

Inclusion Terms
These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.

• Postpartum sepsis
• Puerperal peritonitis
• Puerperal pyemia

Use Additional Code

Use Additional Code
The “use additional code” indicates that a secondary code could be used to further specify the patient’s condition. This note is not mandatory and is only used if enough information is available to assign an additional code.

• code B95 B97

Type 1 Excludes

Type 1 Excludes
A type 1 excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.

• fever of unknown origin following delivery O86.4
• genital tract infection following delivery O86.1
• obstetric pyemic and septic embolism O88.3
• puerperal septic thrombophlebitis O86.81
• urinary tract infection following delivery O86.2

Type 2 Excludes

Type 2 Excludes
A type 2 excludes note represents "Not included here". An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.

• sepsis during labor O75.3

Index to Diseases and Injuries

The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10 code(s). The following references for the code O85 are found in the index:

• - Abscess (connective tissue) (embolic) (fistulous) (infective) (metastatic) (multiple) (pernicious) (pyogenic) (septic) - L02.91
  • - peritoneum, peritoneal (perforated) (ruptured) - K65.1
    • - puerperal, postpartum, childbirth - O85

• - Infection, infected, infective (opportunistic) - B99.9
  • - major
    • - puerperal, postpartum, childbirth - O85
  • - puerperal - O86.4
    • - major or generalized - O85

• - Pelviperitonitis - See Also: Peritonitis, pelvic;
  • - puerperal - O85

• - Peritonitis (adhesive) (bacterial) (fibrinous) (hemorrhagic) (idiopathic) (localized) (perforative) (primary) (with adhesions) (with effusion) - K65.9
  • - puerperal, postpartum, childbirth - O85

• - Puerperal, puerperium (complicated by, complications)
  • - abscess
    • - peritoneum - O85
  • - fever (of unknown origin) - O86.4
    • - septic - O85
  • - infection - O86.4
    • - generalized - O85
    • - peritoneum - O85
  • - metroperitonitis - O85
  • - parametritis - O85
  • - pelviperitonitis - O85
  • - peritoneal infection - O85
  • - peritonitis (pelvic) - O85
  • - pyemia - O85
  • - pyohemia - O85
  • - salpingoperitonitis - O85
  • - sepsis (pelvic) - O85
  • - sepsis - O85

• - Pyemia, pyemic (fever) (infection) (purulent) - See Also: Sepsis;
  • - puerperal, postpartum, childbirth - O85

• - Sepsis (generalized) (unspecified organism) - A41.9
  • - pelvic, puerperal, postpartum, childbirth - O85
  • - puerperal, postpartum, childbirth (pelvic) - O85

Code Edits

The Medicare Code Editor (MCE) detects and reports errors in the coding of claims data. The following ICD-10 Code Edits are applicable to this code:

• Maternity diagnoses - Maternity. Age range is 12–55 years inclusive (e.g., diabetes in pregnancy, antepartum pulmonary complication).
• Diagnoses for females only - Medicare Code Editor detects inconsistencies between a patient’s sex and any diagnosis on the patient’s record, this code applies to FEMALES only .

Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

• Major puerperal infection
• Puerperal pelvic sepsis
• Puerperal peritonitis
• Puerperal peritonitis - delivered with postnatal complication
• Puerperal peritonitis with postnatal complication
• Puerperal sepsis
• Puerperal sepsis with postnatal complication
• Puerperal septicemia - delivered with postnatal complication
• Sepsis following obstructed labor

Convert O85 to ICD-9

• 670.22 - Puerprl sepsis-del w p/p (Approximate Flag)
• 670.24 - Puerperl sepsis-postpart (Approximate Flag)

Code Classification

• Pregnancy, childbirth and the puerperium (O00–O99)
  • Complications predominantly related to the puerperium (O85-O92)
    • Puerperal sepsis (O85)

Code History

• FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016
  (First year ICD-10-CM implemented into the HIPAA code set)
• FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
• FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
• FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
• FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020

Tools

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• Convert O85 to ICD-9