O64.4 vs O66.0
O64.4 (Obstructed labor due to shoulder presentation) compared with O66.0 (Obstructed labor due to shoulder dystocia), from the official CMS tabular data. Do not report these codes together: the official tabular list marks them Excludes1.
Can these codes be reported together?
No — do not report together. O64.4 carries an Excludes1 note covering O66.0: “impacted shoulders (O66.0)”
Sole exception: when the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).
No — do not report together. O64.4 carries an Excludes1 note covering O66.0: “shoulder dystocia (O66.0)”
Sole exception: when the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).
Side by side
| O64.4Obstructed labor due to shoulder presentation | O66.0Obstructed labor due to shoulder dystocia | |
|---|---|---|
| Billing status | Non-billable header Report instead: O64.4XX0, O64.4XX1, O64.4XX2, O64.4XX3, O64.4XX4 | Billable |
| Classification | O00-O9A — Pregnancy, Childbirth and the Puerperium (O00-O9A) | O00-O9A — Pregnancy, Childbirth and the Puerperium (O00-O9A) |
| Definition | Obstructed labor due to shoulder presentation is a non-billable ICD-10-CM category code (O64.4). | Obstructed labor due to shoulder dystocia is a billable ICD-10-CM diagnosis code (O66.0). |
| 7th character | One of the following 7th characters is to be assigned to each code under category O64. 7th character 0 is for single gestations and multiple gestations where the fetus is unspecified. 7th characters 1 through 9 are for cases of multiple gestations to identify the fetus for which the code applies. The appropriate code from category O30, Multiple gestation, must also be assigned when assigning a code from category O64 that has a 7th character of 1 through 9. | — |
| Includes | Prolapsed arm | Impacted shoulders |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources