Excludes1 pair
O64.4- vs O66.0
O64.4 and O66.0 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 O64.4
impacted shoulders (O66.0)
O64.4
Obstructed labor due to shoulder presentation
Not billable
- Chapter 15
- Pregnancy, childbirth and the puerperium
- Section
- O60-O77
Use when the record says
- Prolapsed arm
Indexed under
- Prolapse, prolapsed › arm or hand › causing obstructed labor
- Delivery › complicated › by › shoulder presentation
- Delivery › complicated › by › obstructed labor › due to › prolapsed arm
- Delivery › complicated › by › obstructed labor › due to › shoulder presentation
O66.0
Obstructed labor due to shoulder dystocia
Billable
- Chapter 15
- Pregnancy, childbirth and the puerperium
- Section
- O60-O77
Use when the record says
- Impacted shoulders
Indexed under
- Dystocia › shoulder (girdle)
- Impaction, impacted › shoulder, causing obstructed labor
- Dystocia › shoulder › causing obstructed labor
- Delivery › complicated › by › obstructed labor › due to › impacted shoulders
- Delivery › complicated › by › obstructed labor › due to › dystocia › shoulder
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