Classification of diseases and injuries



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NORMAL DELIVERY, AND OTHER INDICATIONS FOR CARE IN PREGNANCY, LABOR, AND DELIVERY (650-659)

The following fifth-digit subclassification is for use with categories 651-659 to denote the current episode of care:

0 unspecified as to episode of care or not applicable

1 delivered, with or without mention of antepartum condition

2 delivered, with mention of postpartum complication

3 antepartum condition or complication

4 postpartum condition or complication

650 Normal delivery

Delivery requiring minimal or no assistance, with or without episiotomy, without fetal manipulation [e.g., rotation version] or instrumentation [forceps] of a spontaneous, cephalic, vaginal, full-term, single, live-born infant. This code is for use as a single diagnosis code and is not to be used with any other code in the range 630-676.

Use additional code to indicate outcome of delivery (V27.0)

Excludes: breech delivery (assisted) (spontaneous) NOS (652.2)

delivery by vacuum extractor, forceps, cesarean section, or breech extraction, without specified complication (669.5-669.7)

651 Multiple gestation

Requires fifth digit; valid digits are in [brackets] under each code. see beginning of section 650-659 for definitions.

Use additional code to specify placenta status (V91.00-V91.99)

Excludes: fetal conjoined twins (678.1)

651.0 Twin pregnancy

[0,1,3]


Excludes: fetal conjoined twins (678.1)

651.1 Triplet pregnancy

[0,1,3]

651.2 Quadruplet pregnancy



[0,1,3]

651.3 Twin pregnancy with fetal loss and retention of one fetus

[0,1,3]

651.4 Triplet pregnancy with fetal loss and retention of one or more fetus(es)



[0,1,3]

651.5 Quadruplet pregnancy with fetal loss and retention of one or more fetus(es)

[0,1,3]

651.6 Other multiple pregnancy with fetal loss and retention of one or more fetus(es)



[0,1,3]

651.7 Multiple gestation following (elective) fetal reduction

[0,1,3]

Fetal reduction of multiple fetuses reduced to single fetus



651.8 Other specified multiple gestation

[0,1,3]


651.9 Unspecified multiple gestation

[0,1,3]


652 Malposition and malpresentation of fetus

Requires fifth digit; valid digits are in [brackets] under each code. see beginning of section 650-659 for definitions.

Code first any associated obstructed labor (660.0)

652.0 Unstable lie

[0,1,3]

652.1 Breech or other malpresentation successfully converted to cephalic presentation



[0,1,3]

Cephalic version NOS

652.2 Breech presentation without mention of version

[0,1,3]


Breech delivery (assisted) (spontaneous) NOS

Buttocks presentation

Complete breech

Frank breech

Excludes: footling presentation (652.8)

incomplete breech (652.8)

652.3 Transverse or oblique presentation

[0,1,3]


Oblique lie

Transverse lie

Excludes: transverse arrest of fetal head (660.3)

652.4 Face or brow presentation

[0,1,3]

Mentum presentation



652.5 High head at term

[0,1,3]


Failure of head to enter pelvic brim

652.6 Multiple gestation with malpresentation of one fetus or more

[0,1,3]

652.7 Prolapsed arm



[0,1,3]

652.8 Other specified malposition or malpresentation

[0,1,3]

Compound presentation



652.9 Unspecified malposition or malpresentation

[0,1,3]


653 Disproportion

Requires fifth digit; valid digits are in [brackets] under each code. see beginning of section 650-659 for definitions.

Code first any associated obstructed labor (660.1)

653.0 Major abnormality of bony pelvis, not further specified

[0,1,3]

Pelvic deformity NOS



653.1 Generally contracted pelvis

[0,1,3]


Contracted pelvis NOS

653.2 Inlet contraction of pelvis

[0,1,3]

Inlet contraction (pelvis)



653.3 Outlet contraction of pelvis

[0,1,3]


Outlet contraction (pelvis)

653.4 Fetopelvic disproportion

[0,1,3]

Cephalopelvic disproportion NOS



Disproportion of mixed maternal and fetal origin, with normally formed fetus

653.5 Unusually large fetus causing disproportion

[0,1,3]

Disproportion of fetal origin with normally formed fetus



Fetal disproportion NOS

Excludes: that when the reason for medical care was concern for the fetus (656.6)

653.6 Hydrocephalic fetus causing disproportion

[0,1,3]


Excludes: that when the reason for medical care was concern for the fetus (655.0)

653.7 Other fetal abnormality causing disproportion

[0,1,3]

Fetal:


ascites

hydrops


myelomeningocele

sacral teratoma

tumor

Excludes: conjoined twins causing disproportion (678.1)



653.8 Disproportion of other origin

[0,1,3]


Excludes: shoulder (girdle) dystocia (660.4)

653.9 Unspecified disproportion

[0,1,3]

654 Abnormality of organs and soft tissues of pelvis



Requires fifth digit; valid digits are in [brackets] under each code. see beginning of section 650-659 for definitions.

Includes: the listed conditions during pregnancy, childbirth, or the puerperium

Code first any associated obstructed labor (660.2)

Excludes: trauma to perineum and vulva complicating current delivery (664.0-664.9)

654.0 Congenital abnormalities of uterus

[0-4]


Double uterus

Uterus bicornis

654.1 Tumors of body of uterus

[0-4]


Uterine fibroids

654.2 Previous cesarean delivery

[0,1,3]

Uterine scar from previous cesarean delivery



654.3 Retroverted and incarcerated gravid uterus

[0-4]


654.4 Other abnormalities in shape or position of gravid uterus and of neighboring structures

[0-4]


Cystocele

Pelvic floor repair

Pendulous abdomen

Prolapse of gravid uterus

Rectocele

Rigid pelvic floor

654.5 Cervical incompetence

[0-4]


Presence of Shirodkar suture with or without mention of cervical incompetence

654.6 Other congenital or acquired abnormality of cervix

[0-4]

Cicatricial cervix



Polyp of cervix

Previous surgery to cervix

Rigid cervix (uteri)

Stenosis or stricture of cervix

Tumor of cervix

654.7 Congenital or acquired abnormality of vagina

[0-4]

Previous surgery to vagina



Septate vagina

Stenosis of vagina (acquired) (congenital)

Sricture of vagina

Tumor of vagina

654.8 Congenital or acquired abnormality of vulva

[0-4]


Anal sphincter tear (healed) (old) complicating delivery

Fibrosis of perineum

Persistent hymen

Previous surgery to perineum or vulva

Rigid perineum

Tumor of vulva

Excludes: anal sphincter tear (healed) (old) not associated with delivery (569.43)

varicose veins of vulva (671.1)

654.9 Other and unspecified

[0-4]


Uterine scar NEC

655 Known or suspected fetal abnormality affecting management of mother

Requires fifth digit; valid digits are in [brackets] under each code. see beginning of section 650-659 for definitions.

Includes: the listed conditions in the fetus as a reason for observation or obstetrical care of the mother, or for termination of pregnancy

655.0 Central nervous system malformation in fetus

[0,1,3]


Fetal or suspected fetal:

anencephaly

hydrocephalus

spina bifida (with myelomeningocele)

655.1 Chromosomal abnormality in fetus

[0,1,3]


655.2 Hereditary disease in family possibly affecting fetus

[0,1,3]


655.3 Suspected damage to fetus from viral disease in the mother

[0,1,3]


Suspected damage to fetus from maternal rubella

655.4 Suspected damage to fetus from other disease in the mother

[0,1,3]

Suspected damage to fetus from maternal:



alcohol addiction

listeriosis

toxoplasmosis

655.5 Suspected damage to fetus from drugs

[0,1,3]

655.6 Suspected damage to fetus from radiation



[0,1,3]

655.7 Decreased fetal movements

[0,1,3]

655.8 Other known or suspected fetal abnormality, not elsewhere classified



[0,1,3]

Suspected damage to fetus from:

environmental toxins

intrauterine contraceptive device

655.9 Unspecified

[0,1,3]


656 Other known or suspected fetal and placental problems affecting management of mother

Requires fifth digit; valid digits are in [brackets] under each code. see beginning of section 650-659 for definitions.

Excludes: fetal hematologic conditions (678.0)

suspected placental problems not found (V89.02)

656.0 Fetal-maternal hemorrhage

[0,1,3]


Leakage (microscopic) of fetal blood into maternal circulation

656.1 Rhesus isoimmunization

[0,1,3]

Anti-D [Rh] antibodies



Rh incompatibility

656.2 Isoimmunization from other and unspecified blood-group incompatibility

[0,1,3]

ABO isoimmunization



656.3 Fetal distress

[0,1,3]


Fetal metabolic acidemia

Excludes: abnormal fetal acid-base balance (656.8)

abnormality in fetal heart rate or rhythm (659.7)

fetal bradycardia (659.7)

fetal tachycardia (659.7)

meconium in liquor (656.8)

656.4 Intrauterine death

[0,1,3]


Fetal death:

NOS


after completion of 22 weeks' gestation

late


Missed delivery

Excludes: missed abortion (632)

656.5 Poor fetal growth

[0,1,3]


"Light-for-dates"

"Placental insufficiency"

"Small-for-dates"

656.6 Excessive fetal growth

[0,1,3]

"Large-for-dates"



656.7 Other placental conditions

[0,1,3]


Abnormal placenta

Placental infarct

Excludes: placental polyp (674.4)

placentitis (658.4)

656.8 Other specified fetal and placental problems

[0,1,3]


Abnormal acid-base balance

Intrauterine acidosis

Lithopedian

Meconium in liquor

Subchorionic hematoma

656.9 Unspecified fetal and placental problem

[0,1,3]

657 Polyhydramnios



[0,1,3]

Hydramnios

Requires fifth digit; valid digits are in [brackets] under each code. see beginning of section 650-659 for definitions.

Use 0 as fourth digit for category 657

Excludes: suspected polyhydramnios not found (V89.01)

658 Other problems associated with amniotic cavity and membranes

Requires fifth digit; valid digits are in [brackets] under each code. see beginning of section 650-659 for definitions.

Excludes: amniotic fluid embolism (673.1)

suspected problems with amniotic cavity and membranes not found (V89.01)

658.0 Oligohydramnios

[0,1,3]

Oligohydramnios without mention of rupture of membranes



658.1 Premature rupture of membranes

[0,1,3]


Rupture of amniotic sac less than 24 hours prior to the onset of labor

658.2 Delayed delivery after spontaneous or unspecified rupture of membranes

[0,1,3]

Prolonged rupture of membranes NOS



Rupture of amniotic sac 24 hours or more prior to the onset of labor

658.3 Delayed delivery after artificial rupture of membranes

[0,1,3]

658.4 Infection of amniotic cavity



[0,1,3]

Amnionitis

Chorioamnionitis

Membranitis

Placentitis

658.8 Other

[0,1,3]

Amnion nodosum



Amniotic cyst

658.9 Unspecified

[0,1,3]

659 Other indications for care or intervention related to labor and delivery, not elsewhere classified



Requires fifth digit; valid digits are in [brackets] under each code. see beginning of section 650-659 for definitions.

659.0 Failed mechanical induction

[0,1,3]

Failure of induction of labor by surgical or other instrumental methods



659.1 Failed medical or unspecified induction

[0,1,3]


Failed induction NOS

Failure of induction of labor by medical methods, such as oxytocic drugs

659.2 Maternal pyrexia during labor, unspecified

[0,1,3]


659.3 Generalized infection during labor

[0,1,3]


Septicemia during labor

659.4 Grand multiparity

[0,1,3]

Excludes: supervision only, in pregnancy (V23.3)



without current pregnancy (V61.5)

659.5 Elderly primigravida

[0,1,3]

First pregnancy in a woman who will be 35 years of age or older at expected date of delivery



Excludes: supervision only, in pregnancy (V23.81)

659.6 Elderly multigravida

[0,1,3]

Second or more pregnancy in a woman who will be 35 years of age or older at expected date of delivery



Excludes: elderly primigravida (659.5)

supervision only, in pregnancy (V23.82)

659.7 Abnormality in fetal heart rate or rhythm

[0, 1, 3]

Depressed fetal heart tones

Fetal:


bradycardia

tachycardia

Fetal heart rate decelerations

Non-reassuring fetal heart rate or rhythm

659.8 Other specified indications for care or intervention related to labor and delivery

[0,1,3]


Pregnancy in a female less than 16 years of age at expected date of delivery

Very young maternal age

659.9 Unspecified indication for care or intervention related to labor and delivery

[0,1,3]


COMPLICATIONS OCCURRING MAINLY IN THE COURSE OF LABOR AND DELIVERY (660-669)

The following fifth-digit subclassification is for use with categories 660-669 to denote the current episode of care:

0 unspecified as to episode of care or not applicable

1 delivered, with or without mention of antepartum condition

2 delivered, with mention of postpartum complication

3 antepartum condition or complication

4 postpartum condition or complication

660 Obstructed labor

Requires fifth digit; valid digits are in [brackets] under each code. see beginning of section 660-669 for definitions.

660.0 Obstruction caused by malposition of fetus at onset of labor

[0,1,3]

Any condition classifiable to 652, causing obstruction during labor



Use additional code from 652.0-652.9 to identify condition

660.1 Obstruction by bony pelvis

[0,1,3]

Any condition classifiable to 653, causing obstruction during labor



Use additional code from 653.0-653.9 to identify condition

660.2 Obstruction by abnormal pelvic soft tissues

[0,1,3]

Prolapse of anterior lip of cervix



Any condition classifiable to 654, causing obstruction during labor

Use additional code from 654.0-654.9 to identify condition

660.3 Deep transverse arrest and persistent occipitoposterior position

[0,1,3]


660.4 Shoulder (girdle) dystocia

[0,1,3]


Impacted shoulders

660.5 Locked twins

[0,1,3]

660.6 Failed trial of labor, unspecified



[0,1,3]

Failed trial of labor, without mention of condition or suspected condition

660.7 Failed forceps or vacuum extractor, unspecified

[0,1,3]


Application of ventouse or forceps, without mention of condition

660.8 Other causes of obstructed labor

[0,1,3]

Use additional code to identify condition



660.9 Unspecified obstructed labor

[0,1,3]


Dystocia:

NOS


fetal NOS

maternal NOS

661 Abnormality of forces of labor

Requires fifth digit; valid digits are in [brackets] under each code. see beginning of section 660-669 for definitions.

661.0 Primary uterine inertia

[0,1,3]


Failure of cervical dilation

Hypotonic uterine dysfunction, primary

Prolonged latent phase of labor

661.1 Secondary uterine inertia

[0,1,3]

Arrested active phase of labor



Hypotonic uterine dysfunction, secondary

661.2 Other and unspecified uterine inertia

[0,1,3]

Atony of uterus without hemorrhage



Desultory labor

Irregular labor

Poor contractions

Slow slope active phase of labor

Excludes: atony of uterus with hemorrhage (666.1)

postpartum atony of uterus without hemorrhage (669.8)

661.3 Precipitate labor

[0,1,3]


661.4 Hypertonic, incoordinate, or prolonged uterine contractions

[0,1,3]


Cervical spasm

Contraction ring (dystocia)

Dyscoordinate labor

Hourglass contraction of uterus

Hypertonic uterine dysfunction

Incoordinate uterine action

Retraction ring (Bandl's) (pathological)

Tetanic contractions

Uterine dystocia NOS

Uterine spasm

661.9 Unspecified abnormality of labor

[0,1,3]


662 Long labor

Requires fifth digit; valid digits are in [brackets] under each code. see beginning of section 660-669 for definitions.

662.0 Prolonged first stage

[0,1,3]


662.1 Prolonged labor, unspecified

[0,1,3]


662.2 Prolonged second stage

[0,1,3]


662.3 Delayed delivery of second twin, triplet, etc.

[0,1,3]


663 Umbilical cord complications

Requires fifth digit; valid digits are in [brackets] under each code. see beginning of section 660-669 for definitions.

663.0 Prolapse of cord

[0,1,3]


Presentation of cord

663.1 Cord around neck, with compression

[0,1,3]

Cord tightly around neck



663.2 Other and unspecified cord entanglement, with compression

[0,1,3]


Entanglement of cords of twins in mono-amniotic sac

Knot in cord (with compression)

663.3 Other and unspecified cord entanglement, without mention of compression

[0,1,3]


663.4 Short cord

[0,1,3]


663.5 Vasa previa

[0,1,3]


663.6 Vascular lesions of cord

[0,1,3]


Bruising of cord

Hematoma of cord

Thrombosis of vessels of cord

663.8 Other umbilical cord complications

[0,1,3]

Velamentous insertion of umbilical cord



663.9 Unspecified umbilical cord complication

[0,1,3]


664 Trauma to perineum and vulva during delivery

Requires fifth digit; valid digits are in [brackets] under each code. see beginning of section 660-669 for definitions.

Includes: damage from instruments

that from extension of episiotomy

664.0 First-degree perineal laceration

[0,1,4]


Perineal laceration, rupture, or tear involving:

fourchette

hymen

labia


skin

vagina


vulva

664.1 Second-degree perineal laceration

[0,1,4]

Perineal laceration, rupture, or tear (following episiotomy) involving:



pelvic floor

perineal muscles

vaginal muscles

Excludes: that involving anal sphincter (664.2)

664.2 Third-degree perineal laceration

[0,1,4]


Perineal laceration, rupture, or tear (following episiotomy) involving:

anal sphincter

rectovaginal septum

sphincter NOS

Excludes: anal sphincter tear during delivery not associated with third-degree perineal laceration (664.6)

that with anal or rectal mucosal laceration (664.3)

664.3 Fourth-degree perineal laceration

[0,1,4]


Perineal laceration, rupture, or tear as classifiable to 664.2 and involving also:

anal mucosa

rectal mucosa

664.4 Unspecified perineal laceration

[0,1,4]

Central laceration



664.5 Vulval and perineal hematoma

[0,1,4]


664.6 Anal sphincter tear complicating delivery, not associated with third-degree perineal laceration

[0,1,4]


Excludes: third-degree perineal laceration (664.2)

664.8 Other specified trauma to perineum and vulva

[0,1,4]

Periurethral trauma



664.9 Unspecified trauma to perineum and vulva

[0,1,4]


665 Other obstetrical trauma

Requires fifth digit; valid digits are in [brackets] under each code. see beginning of section 660-669 for definitions.

Includes: damage from instruments

665.0 Rupture of uterus before onset of labor

[0,1,3]

665.1 Rupture of uterus during labor



[0,1]

Rupture of uterus NOS

665.2 Inversion of uterus

[0,2,4]


665.3 Laceration of cervix

[0,1,4]


665.4 High vaginal laceration

[0,1,4]


Laceration of vaginal wall or sulcus without mention of perineal laceration

665.5 Other injury to pelvic organs

[0,1,4]

Injury to:



bladder

urethra


Excludes: periurethral trauma (664.8)

665.6 Damage to pelvic joints and ligaments

[0,1,4]

Avulsion of inner symphyseal cartilage



Damage to coccyx

Separation of symphysis (pubis)

665.7 Pelvic hematoma

[0-2,4]


Hematoma of vagina

665.8 Other specified obstetrical trauma

[0-4]

665.9 Unspecified obstetrical trauma



[0-4]

666 Postpartum hemorrhage

Requires fifth digit; valid digits are in [brackets] under each code. see beginning of section 660-669 for definitions.

666.0 Third-stage hemorrhage

[0,2,4]

Hemorrhage associated with retained, trapped, or adherent placenta



Retained placenta NOS

666.1 Other immediate postpartum hemorrhage

[0,2,4]

Atony of uterus with hemorrhage



Hemorrhage within the first 24 hours following delivery of placenta

Postpartum atony of uterus with hemorrhage

Postpartum hemorrhage (atonic) NOS

Excludes: atony of uterus without hemorrhage (661.2)

postpartum atony of uterus without hemorrhage (669.8)

666.2 Delayed and secondary postpartum hemorrhage

[0,2,4]

Hemorrhage:



after the first 24 hours following delivery

associated with retained portions of placenta or membranes

Postpartum hemorrhage specified as delayed or secondary

Retained products of conception NOS, following delivery

666.3 Postpartum coagulation defects

[0,2,4]


Postpartum:

afibrinogenemia

fibrinolysis

667 Retained placenta without hemorrhage

Requires fifth digit; valid digits are in [brackets] under each code. see beginning of section 660-669 for definitions.

667.0 Retained placenta without hemorrhage

[0,2,4]

Placenta accreta without hemorrhage



Retained placenta:

NOS without hemorrhage

total without hemorrhage

667.1 Retained portions of placenta or membranes, without hemorrhage

[0,2,4]

Retained products of conception following delivery, without hemorrhage



668 Complications of the administration of anesthetic or other sedation in labor and delivery

Use additional code(s) to further specify complication

Requires fifth digit; valid digits are in [brackets] under each code. see beginning of section 660-669 for definitions.

Includes: complications arising from the administration of a general or local anesthetic, analgesic, or other sedation in labor and delivery

Excludes: reaction to spinal or lumbar puncture (349.0)

spinal headache (349.0)

668.0 Pulmonary complications

[0-4]


Inhalation [aspiration] of stomach contents or secretions following anesthesia or other sedation in labor or delivery

Mendelson's syndrome following anesthesia or other sedation in labor or delivery

Pressure collapse of lung following anesthesia or other sedation in labor or delivery

668.1 Cardiac complications

[0-4]

Cardiac arrest or failure following anesthesia or other sedation in labor and delivery



668.2 Central nervous system complications

[0-4]


Cerebral anoxia following anesthesia or other sedation in labor and delivery

668.8 Other complications of anesthesia or other sedation in labor and delivery

[0-4]

668.9 Unspecified complication of anesthesia and other sedation



[0-4]

669 Other complications of labor and delivery, not elsewhere classified

Requires fifth digit; valid digits are in [brackets] under each code. see beginning of section 660-669 for definitions.

669.0 Maternal distress

[0-4]

Metabolic disturbance in labor and delivery



669.1 Shock during or following labor and delivery

[0-4]


Obstetric shock

669.2 Maternal hypotension syndrome

[0-4]

669.3 Acute kidney failure following labor and delivery



[0,2,4]

669.4 Other complications of obstetrical surgery and procedures

[0-4]

Cardiac:


arrest following cesarean or other obstetrical surgery or procedure, including delivery NOS

failure following cesarean or other obstetrical surgery or procedure, including delivery NOS

Cerebral anoxia following cesarean or other obstetrical surgery or procedure, including delivery NOS

Excludes: complications of obstetrical surgical wounds (674.1-674.3)

669.5 Forceps or vacuum extractor delivery without mention of indication

[0,1]


Delivery by ventouse, without mention of indication

669.6 Breech extraction, without mention of indication

[0,1]

Excludes: breech delivery NOS (652.2)



669.7 Cesarean delivery, without mention of indication

[0,1]


669.8 Other complications of labor and delivery

[0-4]


669.9 Unspecified complication of labor and delivery

[0-4]

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