ICD-10 O86.04
Billable / Specific MCCSepsis following an obstetrical procedure
About ICD-10-CM O86.04
ICD-10-CM code O86.04 represents Sepsis following an obstetrical procedure. This is a billable/specific code in the Pregnancy, Childbirth, and Puerperium chapter (block O86). The 2026 edition of ICD-10-CM O86.04 became effective on October 1, 2025.
Coding Tips for O86.04
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
O86.04 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.
Use Additional Code
When coding O86.04, also report these additional codes when applicable.
- code to identify the sepsis
Inpatient DRG Impact, MCC
codes Sepsis following an obstetrical procedure. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for O86.04
Local Coverage Determinations (LCDs) from CMS MACs that list O86.04 as a covered diagnosis.
Showing top 9. Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing O86.04.
1 Medicare
CPT Codes Commonly Billed with O86.04
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.
Codes Adjacent To O86.04
Other codes in section O85-O92 (Complications predominantly related to the puerperium).
ICD-10 O86.04, Billing FAQ
Is ICD-10 code O86.04 billable? +
Yes, O86.04 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Is O86.04 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.
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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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