ICD-10 O85
Billable / Specific MCCPuerperal sepsis
About ICD-10-CM O85
ICD-10-CM code O85 represents Puerperal sepsis. This is a billable/specific code in the Pregnancy, Childbirth, and Puerperium chapter (block O85). The 2026 edition of ICD-10-CM O85 became effective on October 1, 2025.
Coding Tips for O85
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
O85 is designated MCC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-MCC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag MCC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Most O codes require a 7th character indicating trimester (1 = first, 2 = second, 3 = third). Some require fetus identification character. Code O09 (supervision of high-risk pregnancy) is required as a secondary code when applicable.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under O85. Per CMS ICD-10-CM Tabular 2026.
- Postpartum sepsis
- Puerperal peritonitis
- Puerperal pyemia
Type 1 Excludes
Pure excludes, these codes can never be coded together with O85. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- fever of unknown origin following delivery (O86.4)
- obstetric pyemic and septic embolism (O88.3-)
- puerperal septic thrombophlebitis (O86.81)
Type 2 Excludes
Not included here, the excluded code is not part of O85, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- genital tract infection following delivery (O86.1-)
- sepsis during labor (O75.3)
- urinary tract infection following delivery (O86.2-)
Use Additional Code
When coding O85, also report these additional codes when applicable.
- code (B95-B97), to identify infectious agent
Inpatient DRG Impact, MCC
codes Puerperal sepsis. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for O85
Local Coverage Determinations (LCDs) from CMS MACs that list O85 as a covered diagnosis.
Showing top 10 of 37 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing O85.
2 Medicare
CPT Codes Commonly Billed with O85
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert O85 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| O85 | 67022 | 10000 |
| O85 | 67024 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To O85
Other codes in section O85-O92 (Complications predominantly related to the puerperium).
ICD-10 O85, Billing FAQ
Is ICD-10 code O85 billable? +
Yes, O85 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to O85? +
ICD-10 O85 includes: Postpartum sepsis; Puerperal peritonitis; Puerperal pyemia.
What codes are Type 1 Excludes for O85? +
Type 1 Excludes (never code together with O85): fever of unknown origin following delivery (O86.4); obstetric pyemic and septic embolism (O88.3-); puerperal septic thrombophlebitis (O86.81)
What codes are Type 2 Excludes for O85? +
Type 2 Excludes (may be coded together when both conditions exist): genital tract infection following delivery (O86.1-); sepsis during labor (O75.3); urinary tract infection following delivery (O86.2-)
Is O85 a CC or MCC for inpatient DRG? +
Yes, this code is designated as MCC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What ICD-9 codes does O85 map to? +
Per CMS GEMs, O85 maps to ICD-9 codes: 67022, 67024. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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