Excludes1 pair
O85 vs O86.4
O85 and O86.4 are not coded together. ICD-10-CM declares them mutually exclusive with an Excludes1 note — the two conditions are not expected to occur together, so exactly one of them is normally correct for a given encounter. The Official Guidelines carve out one exception: if the two conditions are clearly unrelated to each other, both may be reported.
The official note, declared on O85
fever of unknown origin following delivery (O86.4)
O85
Puerperal sepsis
Billable
- Chapter 15
- Pregnancy, childbirth and the puerperium
- Section
- O85-O92
Use when the record says
- Postpartum sepsis
- Puerperal peritonitis
- Puerperal pyemia
Indexed under
- Pelviperitonitis › puerperal
- Peritonitis › puerperal, postpartum, childbirth
- Puerperal, puerperium › metroperitonitis
- Puerperal, puerperium › parametritis
- Puerperal, puerperium › pelviperitonitis
O86.4
Pyrexia of unknown origin following delivery
Billable
- Chapter 15
- Pregnancy, childbirth and the puerperium
- Section
- O85-O92
Use when the record says
- Puerperal infection NOS following delivery
- Puerperal pyrexia NOS following delivery
Indexed under
- Fever › following delivery
- Fever › puerperal
- Infection, infected, infective › puerperal
- Puerperal, puerperium › fever (of unknown origin)
- Puerperal, puerperium › infection
Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027