2025 ICD-10-CM code O86.8
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Pregnancy, childbirth and the puerperium - Complications predominantly related to the puerperium Chapter 15: Pregnancy, childbirth and the puerperium (O00-O9A) Feed
Other specified puerperal infections.
Modifiers may be applicable depending on the specific circumstances and the healthcare provider’s individual services, but this requires further clarification in the context of individual cases.
Medical necessity for coding O86.8 is established by the presence of a confirmed postpartum infection requiring medical intervention.Documentation must support the clinical diagnosis and demonstrate the need for treatment.The severity of the infection and the potential risk to maternal health are factors considered in determining medical necessity.
Obstetrician-gynecologist or other qualified healthcare professional managing postpartum care.Requires appropriate diagnosis and treatment of the infection, including antimicrobial therapy if indicated.
- Chapter 15: Pregnancy, childbirth and the puerperium (O00-O9A)
- O86-O92: Complications predominantly related to the puerperium
In simple words: This code is for infections a mother gets after giving birth that aren't specifically listed in other medical codes.It covers various infections a mother might have after delivery.
This code classifies puerperal infections not specified elsewhere.Puerperal infections are infections occurring in the postpartum period (after childbirth).This code is used when the specific type of infection is not specified or cannot be determined.It encompasses various infections occurring in the mother after delivery, excluding those explicitly detailed in other ICD-10-CM codes within the O86 category.
Example 1: A 30-year-old woman develops a wound infection at the episiotomy site five days postpartum. The infection is not responding to initial treatment, and cultures reveal a mixed bacterial infection.Code O86.8 is used to describe this unspecified puerperal infection.Additional codes from category B95-B97 should be used to specify the infectious agent(s)., A 25-year-old postpartum patient presents with fever, chills, and uterine tenderness two weeks after delivery.A pelvic examination reveals purulent material from the cervix.Laboratory tests confirm a bacterial infection.Since the exact type of puerperal infection is not yet specified, O86.8 is used. Further testing and refined diagnosis may allow for more precise code assignment later., A 35-year-old woman experiences a postpartum fever, elevated white blood cell count, and localized breast pain. She has an area of redness and swelling in her right breast.Mammography confirms an abscess.Although a breast abscess is a specific puerperal infection,if the type of bacteria involved is unclear, code O86.8 may be appropriate pending further investigation and laboratory results. Specific codes from O91 might be applied after confirmed bacterial identification.
Complete obstetrical history including delivery method, any complications during labor or delivery.Detailed physical examination documenting the infection's location, severity, and symptoms.Laboratory results such as complete blood count (CBC), blood cultures, and any cultures from the infected site.Treatment provided including medication prescribed and response to therapy.
** This code should only be used on the maternal record and never on the newborn record.Always use additional codes to specify the infectious agent when possible (B95-B97). The diagnostic confidence indicator (A, G, V, or Z) might be required for outpatient care depending on local regulations.
- Payment Status: Active
- Modifier TC rule: Not applicable. This is a diagnosis code, not a procedure code.
- Specialties:Obstetrics and Gynecology, Infectious Disease
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office