O85 ICD-10-CM Code: Puerperal sepsis
O85 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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FY 2026 Apr update / Pregnancy, childbirth and the puerperium (O00-O9A) / Complications predominantly related to the puerperium (O85-O92)
O85
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePuerperal sepsis
A serious bacterial infection of the uterus and surrounding tissues occurring after childbirth, characterized by fever and systemic illness.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
Context neededHCC 207
Coefficient needs member context
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Postpartum sepsis
- Puerperal peritonitis
- Puerperal pyemia
Excludes 2
Official- genital tract infection following delivery (O86.1-)
- sepsis during labor (O75.3)
- urinary tract infection following delivery (O86.2-)
- mental and behavioral disorders associated with the puerperium (F53.-)Inherited from O00-O9A, O85-O92
- obstetrical tetanus (A34)Inherited from O00-O9A, O85-O92
- postpartum necrosis of pituitary gland (E23.0)Inherited from O00-O9A, O85-O92
- puerperal osteomalacia (M83.0)Inherited from O00-O9A, O85-O92
Related Codes
No related codes are included in this display for O85. Check the Code Book for the complete code path.
Includes
OfficialNo Includes notes are included in this display for O85. Check the code and parent instructions in the Code Book.
Excludes 1
Official- fever of unknown origin following delivery (O86.4)
- obstetric pyemic and septic embolism (O88.3-)
- puerperal septic thrombophlebitis (O86.81)
- supervision of normal pregnancy (Z34.-)Inherited from O00-O9A
Code First
OfficialNo Code First sequencing instructions are included in this display for O85. Check the code and parent instructions in the Code Book.
Use Additional
Official- code (B95-B97), to identify infectious agent
- code (R65.2-) to identify severe sepsis, if applicable
- code, if applicable, from category Z3A, Weeks of gestation, to identify the specific week of the pregnancy, if known.Inherited from O00-O9A
Code Also
OfficialNo Code Also instructions are included in this display for O85. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is O85 an HCC code?
O85 has no mapping under the current CMS-HCC V28 community payment model. O85 also appears in the HHS-HCC commercial risk model (HCC 207 (HHS-HCC 207 adult, RAF varies by metal level)), where the result depends on member context and is not a Medicare Advantage payment mapping.
- Code
- O85
- Description
- Puerperal sepsis
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
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What This Code Means
O85 is the ICD-10-CM diagnosis code for puerperal sepsis. A serious bacterial infection of the uterus and surrounding tissues occurring after childbirth, characterized by fever and systemic illness. O85 sits in the ICD-10-CM chapter for pregnancy, childbirth and the puerperium (o00-o9a), within the section covering complications predominantly related to the puerperium (o85-o92).
O85 has no mapping under the current CMS-HCC V28 community payment model. O85 also appears in the HHS-HCC commercial risk model (HCC 207 (HHS-HCC 207 adult, RAF varies by metal level)), where the result depends on member context and is not a Medicare Advantage payment mapping. Do not assign V28 risk adjustment value from this page; verify the applicable model and payment year before using this code for risk adjustment.
This is a serious postpartum complication requiring antibiotic treatment; document the causative organism if identified.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for O85 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a serious postpartum complication requiring antibiotic treatment; document the causative organism if identified
- •Link to appropriate sepsis codes (R65.2x) if systemic inflammatory response is documented