Is ICD-10-CM code O86 billable?

No, O86 (Other puerperal infections) is a non-billable ICD-10-CM code. It must be coded to a more specific subcategory before it can be used for reimbursement.

What chapter does ICD-10-CM code O86 belong to?

O86 belongs to Chapter 15 of the ICD-10-CM tabular list: O00–O9A (Pregnancy, Childbirth and the Puerperium).

O86Not billable, use a more specific code below

Other puerperal infections

In Complications predominantly related to the puerperium (O85-O92), chapter 15: Pregnancy, Childbirth and the Puerperium

17 billable codes under O86: 3 are an MCC, 9 are a CC; none map to an HCC.A CC or MCC (major CC) is a secondary diagnosis that raises the MS-DRG payment.

Instructional notes

Excludes2: not included here, code separately if applicable

infection during labor (O75.3)
obstetrical tetanus (A34)

Use additional code: add a second code for this, listed after this one

code (B95-B97), to identify infectious agent

Also applies, from Complications predominantly related to the puerperium (O85-O92)

These notes sit on O85-O92 and apply to every code under it, including O86.

Excludes2: not included here, code separately if applicable

mental and behavioral disorders associated with the puerperium (F53.-)
obstetrical tetanus (A34)
puerperal osteomalacia (M83.0)

Official coding guidelines

From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.

Coding of obstetric cases with O00-O9A codes: sequencing priority, trimester and fetus characters, principal diagnosis selection, delivery outcome, and pregnancy-related complications.

General Rules for Obstetric Cases (page 63)
Selection of OB Principal or First-listed Diagnosis (page 64)
Pre-existing conditions versus conditions due to the pregnancy (page 65)
Pre-existing hypertension in pregnancy (page 66)
Fetal Conditions Affecting the Management of the Mother (page 66)
HIV Infection in Pregnancy, Childbirth and the Puerperium (page 66)
Diabetes mellitus in pregnancy (page 66)
Long term use of insulin and oral hypoglycemics (page 67)

Read Section I.C.15 (page 63), 11 more topics

All codes under O86

O86 can't be used on a claim. Pick a billable code below; grey headings group them.

O86 MS-DRGs

As the principal diagnosis, all 17 billable codes under O86 group to MS-DRG 769 or 776 (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

Other codes that refer to O86

Notes on these codes point to O86.

N70-N77 Excludes1: pregnancy, childbirth and the puerperium (O23.-, O75.3, O85, O86.-)
N71 Excludes1: infection of uterus following delivery (O85, O86.-)
O75 Excludes2: puerperal (postpartum) infection (O86.-)
O98 Excludes2: puerperal infection (O86.-)

About the condition

Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.

Infections and Pregnancy

During pregnancy, some common infections such as the common cold or a skin infection do not usually cause serious problems. Some infections, such as the flu, can be more severe when you're pregnant. But other infections can be harmful to you, your fetus, or both.

Postpartum Care

Taking home a new baby is one of the happiest times in a woman's life. But it also presents both physical and emotional challenges. : In addition to physical changes, you may feel sad or have the "baby blues." If you are extremely sad or are unable to care for yourself or your baby, you might have a serious condition called postpartum depression.

Code history

Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.