2027 ICD-10-CM Diagnosis Code O86.04Sepsis following an obstetrical procedure
ICD-10-CM Codes›O00-O9A›O85-O92›O86
- Billable — Valid for Submission
- MCC — Major Complication or Comorbidity
- Not Chronic
O86.04 is a billable ICD-10-CM diagnosis code for sepsis following an obstetrical procedure. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 769, 776. As a secondary diagnosis, it counts as a major complication or comorbidity (MCC) and places an inpatient stay in the highest severity level of its MS-DRG family. It does not count, however, when the principal diagnosis is one of 225 closely related codes. The code is restricted by the Medicare Code Editor to maternity cases (age 9 through 64). In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Complications specified during childbirth and Septicemia.
Code Identity
Code Classification
Code EditsBilling
Medicare Code Editor checks that affect claim validity for O86.04.
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to O86.04: its own notes plus those printed at O86.0, O86, block O85-O92, and Chapter 15. A note printed at a category, block or chapter applies to every code under it.
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
- supervision of normal pregnancy (Z34.-)
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
Use Additional Code
Add a second code, after this one, to fully describe the condition.
- code to identify the sepsis
- code, if applicable, from category Z3A, Weeks of gestation, to identify the specific week of the pregnancy, if known.
Notes
General instructions on how these codes are used.
- CODES FROM THIS CHAPTER ARE FOR USE ONLY ON MATERNAL RECORDS, NEVER ON NEWBORN RECORDS
- Codes from this chapter are for use for conditions related to or aggravated by the pregnancy, childbirth, or by the puerperium (maternal causes or obstetric causes)
- Trimesters are counted from the first day of the last menstrual period. They are defined as follows:
- 1st trimester- less than 14 weeks 0 days
- 2nd trimester- 14 weeks 0 days to less than 28 weeks 0 days
- 3rd trimester- 28 weeks 0 days until delivery
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name O86.04, its category, or a range that includes it.
Excludes1 2
These codes carry an Excludes1 note naming O86.04: they are not reported together with it, unless the two conditions are unrelated.
- Block N70-N77 Inflammatory diseases of female pelvic organspregnancy, childbirth and the puerperium (O23.-, O75.3, O85, O86.-) names O86.-, which includes this code
- N71 Inflammatory disease of uterus, except cervixinfection of uterus following delivery (O85, O86.-) names O86.-, which includes this code
Excludes2 4
These codes carry an Excludes2 note naming O86.04: its condition is not part of those codes, and both may be reported when the patient has both.
- O75 Other complications of labor and delivery, not elsewhere classifiedpuerperal (postpartum) infection (O86.-) names O86.-, which includes this code
- O75.4 Other complications of obstetric surgery and proceduresinfection of obstetrical (surgical) wound (O86.0-) names O86.0-, which includes this code
- O98 Maternal infectious and parasitic diseases classifiable elsewhere but complicating pregnancy, childbirth and the puerperiumpuerperal infection (O86.-) names O86.-, which includes this code
- T81.4 Infection following a procedureobstetric surgical wound infection (O86.0-) names O86.0-, which includes this code
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
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.
Read the full article at MedlinePlus
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Code History & ChangesHistory
Replacement O86.04 replaces the following previously assigned code(s):
- O86.0 - Infection of obstetric surgical wound
Questions About O86.04Overview
What is the ICD-10 code for sepsis following an obstetrical procedure?
The ICD-10-CM code for sepsis following an obstetrical procedure is O86.04 (sometimes written as O8604). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is O86.04 (Infection of obstetric surgical wound) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report sepsis following an obstetrical procedure on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does O86.04 group to?
When sepsis following an obstetrical procedure is the principal diagnosis on an inpatient stay, it groups to MS-DRG 769, 776, with relative weights from 0.6718 to 1.6666 depending on complications. Higher weights mean higher Medicare reimbursement.
Is O86.04 a CC or MCC?
CMS lists O86.04 as an MCC (major complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it places the inpatient stay in the highest-weighted DRG of its severity family. It does not count when the principal diagnosis is one of the 225 closely related codes in its exclusion list.
Who can O86.04 be reported for?
The Medicare Code Editor checks sepsis following an obstetrical procedure against patient demographics: this code is intended for maternity cases (age 9 through 64). Claims outside these limits are flagged as inconsistent.
