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O65.4 ICD-10-CM Code: Obstructed labor due to fetopelvic disproportion, unspecified

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 Excludes1

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v44, Appendix B.

  • MS-DRG 817 — OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC (MDC 14)
  • MS-DRG 818 — OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC (MDC 14)
  • MS-DRG 819 — OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC (MDC 14)
  • MS-DRG 831 — OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC (MDC 14)
  • MS-DRG 832 — OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC (MDC 14)
  • MS-DRG 833 — OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC (MDC 14)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for O65.4 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Coder workflow for O65.4

MedCoder structured workflow — derived from this code’s own official record

Before you code O65.4

  1. Unspecified does not mean incorrect. When the record gives no greater specificity, O65.4 may be the appropriate code. Check the record for detail that supports a more specific sibling. An unspecified code is for records that do not provide the detail a more specific code needs; a query, not an assumption, is the route to specificity (Guidelines I.A.9.b, I.B.18).

    ReviewO65.0, O65.1, O65.2, O65.3, O65.5, O65.8

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

  2. O65.4’s title joins a condition with an associated condition or complication. Confirm each component is documented. Where the classification presumes the link through the “with” convention, only a provider statement that the conditions are unrelated defeats it. A combination code is assigned only when it fully identifies the documented conditions; a required second code for the stage, type or manifestation is still reported when the notes ask for it (Guidelines I.B.9, I.A.15).

    Guide: Combination codes →

  3. Confirm the condition is documented as complicating the pregnancy, childbirth, or the puerperium, and check the trimester where the code carries one and the fetus character where the category requires it. Chapter 15 codes belong on the maternal record only and take sequencing priority over codes from other chapters. It is the provider’s responsibility to state that a condition is not affecting the pregnancy; the trimester is assigned from the documentation (Guidelines I.C.15.a, I.C.15.a.1, I.C.15.a.3).

    Guide: How to choose an ICD-10-CM code →

  4. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with O65.4. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the record document the detail a more specific sibling code needs?
    Yes → Review the specific siblings in this subcategory.
    No → Continue — O65.4 is appropriate when the documentation goes no further.

    ReviewO65.0, O65.1, O65.2, O65.3, O65.5, O65.8

  2. Does the documentation support a condition named in O65.4’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

Consider O65.4. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Trimester
Assigned from the documented trimester at the encounter, or the trimester in which the condition developed for inpatient stays (Guidelines I.C.15.a.3).
The associated condition or complication
Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).
Any detail beyond this code’s title
What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes1 — check before selecting O65.4(1 note)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with O65.4: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    See the official tabular notes · Guidelines I.A.12.a

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: The provider documents the condition in the terms of this code’s title and records no further detail.

Coding question: Is a more specific sibling code supportable?

Path: Review the specific siblings in this subcategory and what each requires the record to state.

Reason: A more specific code needs documentation of the distinguishing element; without it the unspecified code is appropriate, and a provider query is the route to specificity (Guidelines I.A.9.b, I.B.18).

ReviewO65.0, O65.1, O65.2, O65.3, O65.5, O65.8

Documentation: Both the condition O65.4 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

Documentation: Only one of the components this code’s title joins is documented.

Coding question: Is O65.4 supported?

Path: Review the code for the documented component on its own.

Reason: A combination code is assigned only when it fully identifies the documented conditions; otherwise the documented component takes its own code (Guidelines I.B.9).

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse O65.4 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of O65.4 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • O66.2— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of dystocia due to abnormality of fetus moves the case to O66.2; the two are not reported together unless documented as unrelated.

    Full comparison: O65.4 vs O66.2 →

  • O66.3— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of dystocia due to abnormality of fetus moves the case to O66.3; the two are not reported together unless documented as unrelated.

    Full comparison: O65.4 vs O66.3 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Code Overview

Obstructed labor due to fetopelvic disproportion, unspecified is a billable ICD-10-CM diagnosis code (O65.4).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (1)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Verify Before Coding

  • Age-restricted: the Medicare Code Editor lists this as a maternity (age 9-64) diagnosis; other ages are presumed incorrect.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name O65.4 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Excludes1 note: O33 — Maternal care for disproportion (via O65.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 6 MS-DRGs: DRG 817 (MDC 14), DRG 818 (MDC 14), DRG 819 (MDC 14), DRG 831 (MDC 14), DRG 832 (MDC 14), DRG 833 (MDC 14).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):PRG024 — Malposition, disproportion or other labor complications (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Malposition, disproportion or other labor complications).

O64.9XX1 — Obstructed labor due to malposition and malpresentation, unspecified, fetus 1, O64.9XX2 — Obstructed labor due to malposition and malpresentation, unspecified, fetus 2, O64.9XX3 — Obstructed labor due to malposition and malpresentation, unspecified, fetus 3, O64.9XX4 — Obstructed labor due to malposition and malpresentation, unspecified, fetus 4, O64.9XX5 — Obstructed labor due to malposition and malpresentation, unspecified, fetus 5, O64.9XX9 — Obstructed labor due to malposition and malpresentation, unspecified, other fetus, O65.0 — Obstructed labor due to deformed pelvis, O65.1 — Obstructed labor due to generally contracted pelvis, O65.2 — Obstructed labor due to pelvic inlet contraction, O65.3 — Obstructed labor due to pelvic outlet and mid-cavity contraction, O65.5 — Obstructed labor due to abnormality of maternal pelvic organs, O65.8 — Obstructed labor due to other maternal pelvic abnormalities, O65.9 — Obstructed labor due to maternal pelvic abnormality, unspecified, O66.0 — Obstructed labor due to shoulder dystocia, O66.1 — Obstructed labor due to locked twins, O66.2 — Obstructed labor due to unusually large fetus, O66.3 — Obstructed labor due to other abnormalities of fetus, O66.40 — Failed trial of labor, unspecified, O66.41 — Failed attempted vaginal birth after previous cesarean delivery, O66.5 — Attempted application of vacuum extractor and forceps, +239 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Delivery”; these codes share that main term but sit in a different category of the Tabular List.

O63.2 — Delayed delivery of second twin, triplet, etc. (delayed NOS, second twin, triplet, etc.), O63.9 — Long labor, unspecified (delayed NOS), O64.0 — Obstructed labor due to incomplete rotation of fetal head (complicated, by, obstructed labor, due to, deep transverse arrest), O64.1 — Obstructed labor due to breech presentation (complicated, by, obstructed labor, due to, breechpresentation), O64.2 — Obstructed labor due to face presentation (complicated, by, obstructed labor, due to, chin presentation), O64.3 — Obstructed labor due to brow presentation (complicated, by, obstructed labor, due to, brow presentation), O64.4 — Obstructed labor due to shoulder presentation (complicated, by, shoulder presentation), O64.5 — Obstructed labor due to compound presentation (complicated, by, obstructed labor, due to, compound presentation), O64.8 — Obstructed labor due to other malposition and malpresentation (complicated, by, obstructed labor, due to, footling presentation), O64.9 — Obstructed labor due to malposition and malpresentation, unspecified (complicated, by, obstructed labor, due to, malposition), O66.0 — Obstructed labor due to shoulder dystocia (complicated, by, obstructed labor, due to, impacted shoulders), O66.1 — Obstructed labor due to locked twins (complicated, by, obstructed labor, due to, locked twins), O66.2 — Obstructed labor due to unusually large fetus (complicated, by, obstructed labor, due to, large fetus), O66.3 — Obstructed labor due to other abnormalities of fetus (complicated, by, fetal, deformity), O66.40 — Failed trial of labor, unspecified (cesarean, failed, trial of labor NOS), O66.41 — Failed attempted vaginal birth after previous cesarean delivery (cesarean, failed, trial of labor NOS, following previous cesarean delivery), O66.5 — Attempted application of vacuum extractor and forceps (cesarean, failed, forceps), O66.6 — Obstructed labor due to other multiple fetuses (complicated, by, obstructed labor, due to, multiple fetuses NEC), O66.8 — Other specified obstructed labor (complicated, by, dilatation, bladder), O66.9 — Obstructed labor, unspecified (complicated, by, obstructed labor, due to, dystocia), +170 more

Contextual Map

Every relationship of O65.4 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run O65.4 with these 3 related codes in Claim Check

Hierarchy

Excludes1

Referenced by Excludes1 notes

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • MDC 14 — Pregnancy, Childbirth and the Puerperium[MDC crossing]: “Pregnancy, Childbirth and the Puerperium — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 94 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027

Index entries

  • Delivery (childbirth) (labor), complicated, by, obstructed labor, due to, fetopelvic disproportion[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v44 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "O65.4 — Obstructed labor due to fetopelvic disproportion, unspecified." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/o65.4-obstructed-labor-due-to-fetopelvic-disproportion-unspecified

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Obstructed labor due to fetopelvic disproportion, unspecified

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to O65.4 in its code family, with their registry titles.

View all codes in the O65 family