ICD-10 O86.0
Non-Billable HeaderInfection of obstetric surgical wound
About ICD-10-CM O86.0
ICD-10-CM code O86.0 represents Infection of obstetric surgical wound. This is a non-billable header code in the Pregnancy, Childbirth, and Puerperium chapter (block O86). The 2026 edition of ICD-10-CM O86.0 became effective on October 1, 2025. Non-billable codes cannot be used as a primary or secondary diagnosis on a claim, use a more specific child code instead.
Coding Tips for O86.0
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
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 O86.0. Per CMS ICD-10-CM Tabular 2026.
- Infected cesarean delivery wound following delivery
- Infected perineal repair following delivery
Type 1 Excludes
Pure excludes, these codes can never be coded together with O86.0. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- complications of procedures, not elsewhere classified (T81.4-)
- postprocedural fever NOS (R50.82)
- postprocedural retroperitoneal abscess (K68.11)
Medicare LCD Coverage for O86.0
Local Coverage Determinations (LCDs) from CMS MACs that list O86.0 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing O86.0.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but O86.0 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with O86.0
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 O86.0 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 |
|---|---|---|
| O86.0 | 67432 | 10000 |
| O86.0 | 67434 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To O86.0
Other codes in section O85-O92 (Complications predominantly related to the puerperium).
ICD-10 O86.0, Billing FAQ
Is ICD-10 code O86.0 billable? +
No, O86.0 is a non-billable header code. Use a more specific child code from block O86 when submitting claims.
What other names or terms map to O86.0? +
ICD-10 O86.0 includes: Infected cesarean delivery wound following delivery; Infected perineal repair following delivery.
What codes are Type 1 Excludes for O86.0? +
Type 1 Excludes (never code together with O86.0): complications of procedures, not elsewhere classified (T81.4-); postprocedural fever NOS (R50.82); postprocedural retroperitoneal abscess (K68.11)
What ICD-9 codes does O86.0 map to? +
Per CMS GEMs, O86.0 maps to ICD-9 codes: 67432, 67434. 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 May 31, 2026.
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