Excludes1 pair
O70.2- vs O70.4
O70.2 and O70.4 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 O70.2
anal sphincter tear during delivery without third degree perineal laceration (O70.4)
O70.2
Third degree perineal laceration during delivery
Not billable
- Chapter 15
- Pregnancy, childbirth and the puerperium
- Section
- O60-O77
Use when the record says
- Perineal laceration, rupture or tear during delivery as in O70.1, also involving anal sphincter
- Perineal laceration, rupture or tear during delivery as in O70.1, also involving rectovaginal septum
- Perineal laceration, rupture or tear during delivery as in O70.1, also involving sphincter NOS
O70.4
Anal sphincter tear complicating delivery, not associated with third degree laceration
Billable
- Chapter 15
- Pregnancy, childbirth and the puerperium
- Section
- O60-O77
Indexed under
- Tear, torn › anus, anal › complicating delivery › without third degree perineal laceration
- Delivery › complicated › by › laceration › anus (sphincter)
- Delivery › complicated › by › laceration › anus › without third degree laceration
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