2027 ICD-10-CM Diagnosis Code O70.4Anal sphincter tear complicating delivery, not associated with third degree laceration
ICD-10-CM Codes›O00-O9A›O60-O77›O70
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Not Chronic
O70.4 is a billable ICD-10-CM diagnosis code for anal sphincter tear complicating delivery, not associated with third degree laceration. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 769, 776. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 254 closely related codes. The code is restricted by the Medicare Code Editor to maternity cases (age 9 through 64). In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under OB-related trauma to perineum and vulva.
Code Identity
Code Classification
Code EditsBilling
Medicare Code Editor checks that affect claim validity for O70.4.
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to O70.4: its own notes plus those printed at O70 and Chapter 15. A note printed at a category, block or chapter applies to every code under it.
Includes
Further defines, or gives examples of, the content of the category.
- episiotomy extended by laceration
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
- anal sphincter tear with third degree perineal laceration (O70.2-)
- obstetric high vaginal laceration alone (O71.4)
- supervision of normal pregnancy (Z34.-)
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
Use Additional Code
Add a second code, after this one, to fully describe the condition.
- code, if applicable, from category Z3A, Weeks of gestation, to identify the specific week of the pregnancy, if known.
Notes
General instructions on how these codes are used.
- CODES FROM THIS CHAPTER ARE FOR USE ONLY ON MATERNAL RECORDS, NEVER ON NEWBORN RECORDS
- Codes from this chapter are for use for conditions related to or aggravated by the pregnancy, childbirth, or by the puerperium (maternal causes or obstetric causes)
- Trimesters are counted from the first day of the last menstrual period. They are defined as follows:
- 1st trimester- less than 14 weeks 0 days
- 2nd trimester- 14 weeks 0 days to less than 28 weeks 0 days
- 3rd trimester- 28 weeks 0 days until delivery
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name O70.4, its category, or a range that includes it.
Excludes1 5
These codes carry an Excludes1 note naming O70.4: they are not reported together with it, unless the two conditions are unrelated.
- O70.2 Third degree perineal laceration during deliveryanal sphincter tear during delivery without third degree perineal laceration (O70.4)
- N89.8 Other specified noninflammatory disorders of vaginacurrent obstetric trauma (O70.-, O71.4, O71.7-O71.8) names O70.-, which includes this code
- N90 Other noninflammatory disorders of vulva and perineumcurrent obstetric trauma (O70.-, O71.7-O71.8) names O70.-, which includes this code
- O71.4 Obstetric high vaginal laceration aloneobstetric high vaginal laceration with perineal laceration (O70.-) names O70.-, which includes this code
- S31.4 Open wound of vagina and vulvainjury to vagina and vulva during delivery (O70.-, O71.4) names O70.-, which includes this code
Excludes2 1
These codes carry an Excludes2 note naming O70.4: its condition is not part of those codes, and both may be reported when the patient has both.
- Chapter 19 (S00-T88) Injury, poisoning and certain other consequences of external causes
Index to Diseases and InjuriesGuidance
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Postpartum Care
Taking home a new baby is one of the happiest times in a woman's life. But it also presents both physical and emotional challenges. :
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Convert O70.4 to ICD-9-CMHistory
Code HistoryHistory
Questions About O70.4Overview
Is O70.4 (Perineal laceration during delivery) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report anal sphincter tear complicating delivery, not associated with third degree laceration on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does O70.4 group to?
When anal sphincter tear complicating delivery, not associated with third degree laceration is the principal diagnosis on an inpatient stay, it groups to MS-DRG 769, 776, with relative weights from 0.6718 to 1.6666 depending on complications. Higher weights mean higher Medicare reimbursement.
Is O70.4 a CC or MCC?
CMS lists O70.4 as a CC (complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 254 closely related codes in its exclusion list.
Who can O70.4 be reported for?
The Medicare Code Editor checks anal sphincter tear complicating delivery, not associated with third degree laceration against patient demographics: this code is intended for maternity cases (age 9 through 64). Claims outside these limits are flagged as inconsistent.
Can O70.4 be reported with a code from O70.2?
Not as a rule. The Excludes1 note on O70.4 lists "anal sphincter tear with third degree perineal laceration (O70.2-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
