2025 ICD-10-CM code O86.09
(Active) Effective Date: N/A Revision Date: N/A Obstetric Complications - Complications predominantly related to the puerperium Chapter 15: Pregnancy, childbirth and the puerperium Feed
Infection of an obstetric surgical wound at a site other than those specified in codes O86.00-O86.03.
Modifiers may be applicable depending on the circumstances of the service, such as the location of service or the type of provider.Consult the appropriate payer guidelines.
The medical necessity for coding O86.09 is established by the presence of a post-operative infection related to the obstetric surgical procedure.This requires documented evidence of infection, such as symptoms, lab results, and treatment received.
Obstetricians and gynecologists are primarily responsible for the diagnosis and treatment of this condition.Infectious disease specialists may also be involved in complex cases.
In simple words: This code is used when a mother develops an infection in a surgical wound after childbirth or an obstetric procedure. The infection must be related to the surgery and is not one of the specific types already listed in other codes.Doctors will use other codes to describe what caused the infection and whether it is severe.
This code classifies infections affecting obstetric surgical wounds, excluding those specified in codes O86.00 through O86.03 (unspecified, superficial incisional, deep incisional, and organ/space sites).It applies to infections occurring after an obstetric surgical procedure, such as a Cesarean section, episiotomy repair, or other related surgeries.The infection must be directly related to the surgical procedure.Additional codes should be used to specify the infectious agent (B95-B97) and any resulting sepsis (O86.04 or T81.44).
Example 1: A 30-year-old female patient undergoes a Cesarean section.Five days post-op, she presents with redness, swelling, and purulent drainage at the incision site. Cultures reveal Staphylococcus aureus.O86.09 is assigned along with a code from B95-B97 to specify the infectious agent., A 25-year-old female patient had an episiotomy repair following a vaginal delivery.She develops a localized infection at the repair site one week later. The site is considered other than the specified sites in O86.00-O86.03. O86.09 is assigned with a code specifying the infectious organism., A 35-year-old patient undergoes a post-partum tubal ligation.She develops a deep infection at the surgical site, but the location is not specified as superficial or deep incisional, or organ/space. O86.09 is coded, along with the infectious agent and sepsis code if applicable.
Complete medical history, physical examination findings, operative report detailing the surgical procedure, microbiology reports detailing culture and sensitivity results, imaging studies (if performed), and documentation of treatment (e.g., antibiotics administered).
** This code is for use only on maternal records, not newborn records.The diagnosis must be directly related to pregnancy, childbirth, or the puerperium.
- Payment Status: Active
- Modifier TC rule: The application of a Technical Component (TC) modifier is not usually applicable to diagnosis codes.
- Specialties:Obstetrics and Gynecology, Infectious Disease
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center