O64.4 vs O66.0
O64.4 and O66.0 can never be reported together. ICD-10-CM declares them mutually exclusive with an Excludes1 note, meaning the two conditions cannot occur in the same patient — so exactly one of them is correct for any given encounter.
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 (childbirth) (labor)
- Delivery › complicated › by › obstructed labor › due to › prolapsed arm (childbirth) (labor)
- Delivery › complicated › by › obstructed labor › due to › shoulder presentation (childbirth) (labor)
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
- Impaction, impacted › shoulder, causing obstructed labor
- Dystocia › shoulder › causing obstructed labor
- Delivery › complicated › by › obstructed labor › due to › impacted shoulders (childbirth) (labor)
- Delivery › complicated › by › obstructed labor › due to › dystocia › shoulder (childbirth) (labor)
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