2025 ICD-10-CM code O86.1
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Complications predominantly related to the puerperium - Other puerperal infections Chapter 15: Pregnancy, childbirth and the puerperium (O00-O9A) Feed
Other infection of the genital tract following delivery.
Modifiers may be applicable depending on the circumstances of the encounter and services rendered. Consult appropriate modifier guidelines.
Medical necessity is established by the presence of symptoms and signs consistent with a postpartum genital tract infection, confirmed by appropriate diagnostic testing and requiring treatment with antibiotics or other interventions.
Obstetrician-gynecologist or other qualified healthcare professional managing postpartum care.May require consultation with infectious disease specialist depending on severity and type of infection.
In simple words: This code is used when a woman develops an infection in her reproductive organs after giving birth. This is not for infections that happened during labor.
This code classifies any infection of the female genital tract that occurs after childbirth, excluding those specifically listed elsewhere (e.g., infections during labor).It encompasses a broad range of infections, and further specification of the causative organism may be necessary using additional codes (B95-B97).
Example 1: A 30-year-old woman, three days postpartum, presents with fever, lower abdominal pain, and purulent vaginal discharge.A diagnosis of postpartum endometritis is made. Code O86.1 is assigned., A 25-year-old woman, one week postpartum, experiences worsening vaginal pain and foul-smelling discharge, and is diagnosed with a postpartum vaginal infection caused by *E. coli*.Codes O86.1 and B96.2 (E.coli) are assigned., A 35-year-old woman, two weeks postpartum, presents with symptoms of a urinary tract infection including dysuria and frequency.Culture confirms *Staphylococcus aureus*. Codes O86.2 (Urinary tract infection following delivery) and B95.61 (Staphylococcus aureus) are applied.
Complete obstetrical history including mode of delivery, presence of risk factors for infection (e.g., prolonged labor, operative delivery, chorioamnionitis). Detailed physical examination, lab results (complete blood count, culture and sensitivity of vaginal/urine specimen), and documentation of treatment plan.
** This code should only be used on maternal records, never on newborn records.Always use the most specific code possible based on the available clinical documentation.Payers may have specific requirements for documentation and coding of postpartum infections.
- Payment Status: Active
- Modifier TC rule: Not applicable to this diagnosis code.
- Specialties:Obstetrics and Gynecology, Infectious Disease
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office