2024 ICD-10-CM Diagnosis Code O86.04
Sepsis following an obstetrical procedure
- ICD-10-CM Code:
- O86.04
- ICD-10 Code for:
- Sepsis following an obstetrical procedure
- Is Billable?
- Yes - Valid for Submission
- Chronic Condition Indicator: [1]
- Not chronic
- Code Navigator:
O86.04 is a billable diagnosis code used to specify a medical diagnosis of sepsis following an obstetrical procedure. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024.
The code O86.04 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.
Clinical Classification
| Clinical Category | CCSR Category Code | Inpatient Default CCSR | Outpatient Default CCSR |
|---|---|---|---|
| Complications specified during childbirth | PRG023 | Y - Yes, default inpatient assignment for principal diagnosis or first-listed diagnosis. | Y - Yes, default outpatient assignment for principal diagnosis or first-listed diagnosis. |
| Septicemia | INF002 | N - Not default inpatient assignment for principal diagnosis or first-listed diagnosis. | N - Not default outpatient assignment for principal diagnosis or first-listed diagnosis. |
Tabular List of Diseases and Injuries
The following annotation back-references are applicable to this diagnosis code. The Tabular List of Diseases and Injuries is a list of ICD-10-CM codes, organized "head to toe" into chapters and sections with coding notes and guidance for inclusions, exclusions, descriptions and more.
Use Additional Code
Use Additional CodeThe “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 to identify the sepsis
Index to Diseases and Injuries References
The following annotation back-references for this diagnosis code are found in the injuries and diseases index. The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10-CM code(s).
- - Sepsis (generalized) (unspecified organism) - A41.9
- - following
- - obstetrical procedure - O86.04
- - following
Code Edits
The Medicare Code Editor (MCE) detects and reports errors in the coding of claims data. The following ICD-10-CM Code Edits are applicable to this code:
- Maternity diagnoses - The Medicare Code Editor detects inconsistencies in maternity cases by checking a patient's age and any diagnosis on the patient's record. The maternity code edits apply to patients age ange is 9–64 years inclusive (e.g., diabetes in pregnancy, antepartum pulmonary complication).
- Diagnoses for females only - The Medicare Code Editor detects inconsistencies between a patient’s sex and any diagnosis on the patient’s record, these edits apply to FEMALES only .
Replacement Code
O8604 replaces the following previously assigned ICD-10-CM code(s):
- O86.0 - Infection of obstetric surgical wound
Patient Education
After Surgery
After any operation, you'll have some side effects. There is usually some pain with surgery. There may also be swelling and soreness around the area that the surgeon cut. Your surgeon can tell you which side effects to expect.
There can also be complications. These are unplanned events linked to the operation. Some complications are infection, too much bleeding, reaction to anesthesia, or accidental injury. Some people have a greater risk of complications because of other medical conditions.
Your surgeon can tell you how you might feel and what you will be able to do - or not do - the first few days, weeks, or months after surgery. Some other questions to ask are:
- How long you will be in the hospital
- What kind of supplies, equipment, and help you might need when you go home
- When you can go back to work
- When it is ok to start exercising again
- Are they any other restrictions in your activities
Following your surgeon's advice can help you recover as soon as possible.
Agency for Healthcare Research and Quality
[Learn More in MedlinePlus]
Sepsis
What is sepsis?
Sepsis is your body's overactive and extreme response to an infection. Sepsis is a life-threatening medical emergency. Without quick treatment, it can lead to tissue damage, organ failure, and even death.
What causes sepsis?
Sepsis happens when an infection you already have triggers a chain reaction throughout your body. Bacterial infections are the most common cause, but other types of infections can also cause it.
The infections are often in the lungs, stomach, kidneys, or bladder. It's possible for sepsis to begin with a small cut that gets infected or with an infection that develops after surgery. Sometimes, sepsis can occur in people who didn't even know that they had an infection.
Who is at risk for sepsis?
Anyone with an infection could get sepsis. But certain people are at higher risk:
- Adults 65 or older
- People with chronic conditions, such as diabetes, lung disease, cancer, and kidney disease
- People with weakened immune systems
- Pregnant women
- Children younger than one
What are the symptoms of sepsis?
Sepsis can cause one or more of these symptoms:
- Rapid breathing and heart rate
- Shortness of breath
- Confusion or disorientation
- Extreme pain or discomfort
- Fever, shivering, or feeling very cold
- Clammy or sweaty skin
It's important to get medical care right away if you think you might have sepsis or if your infection is not getting better or is getting worse.
What other problems can sepsis cause?
Severe cases of sepsis can lead to septic shock, where your blood pressure drops to a dangerous level and multiple organs can fail.
How is sepsis diagnosed?
Your health care provider may use many tools to make a diagnosis:
- A medical history, which includes asking about your symptoms
- A physical exam, including checking vital signs (your temperature, blood pressure, heart rate, and breathing)
- Lab tests that check for signs of infection or organ damage
- Imaging tests such as an x-ray or a CT scan to find the location of the infection
Many of the signs and symptoms of sepsis can also be caused by other medical conditions. This may make sepsis hard to diagnose in its early stages.
What are the treatments for sepsis?
It is very important to get treatment right away. Treatment usually includes:
- Antibiotics
- Maintaining blood flow to organs. This may involve getting oxygen and intravenous (IV) fluids.
- Treating the source of the infection
- If needed, medicines to increase blood pressure
In serious cases, you might need kidney dialysis or a breathing tube. Some people need surgery to remove tissue damaged by the infection.
Can sepsis be prevented?
To prevent sepsis, you should try to prevent getting an infection:
- Take good care of any chronic health conditions that you have
- Get recommended vaccines
- Practice good hygiene, such as handwashing
- Keep cuts clean and covered until healed
NIH: National Institute of General Medical SciencesCenters for Disease Control and Prevention
[Learn More in MedlinePlus]
Code History
- FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
- FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
- FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
- FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
- FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
- FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
Footnotes
[1] Not chronic - A diagnosis code that does not fit the criteria for chronic condition (duration, ongoing medical treatment, and limitations) is considered not chronic. Some codes designated as not chronic are acute conditions. Other diagnosis codes that indicate a possible chronic condition, but for which the duration of the illness is not specified in the code description (i.e., we do not know the condition has lasted 12 months or longer) also are considered not chronic.