Excludes1 pair
O70- vs O70.4
O70 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 O70.4
anal sphincter tear with third degree perineal laceration (O70.2-)
O70
Perineal laceration during delivery
Not billable
- Chapter 15
- Pregnancy, childbirth and the puerperium
- Section
- O60-O77
Use when the record says
- episiotomy extended by laceration
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