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O70.4 ICD-10-CM Code: Anal sphincter tear complicating delivery, not associated with third degree laceration

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

Coding at a Glance

Tabular directives
1 inclusion term · 2 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 v43, Appendix B.

  • MS-DRG 769 — POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES (MDC 14)
  • MS-DRG 776 — POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES (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 O70.4 in the official ICD-10-CM tabular list, quoted as published.

Notes without a marker are published on O70.4 itself; “inherited from” names the category or block whose note applies here.

Includes

Conditions the official ICD-10-CM tabular list includes under this code.

  • episiotomy extended by laceration

Source: inherited from O70

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 O70.4

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

Before you code O70.4

  1. O70.4’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 →

  2. 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 →

  3. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with O70.4. 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 documentation support a condition named in O70.4’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.

    ReviewO70.2, O71.4

Consider O70.4. 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).

Official instructions as workflow

  • Excludes1 — check before selecting O70.4(2 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with O70.4: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareO70.2, O71.4

    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: Both the condition O70.4 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).

ReviewO70.2, O71.4

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

Coding question: Is O70.4 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.

Code Overview

Anal sphincter tear complicating delivery, not associated with third degree laceration is a billable ICD-10-CM diagnosis code (O70.4).

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 (3)

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.
  • CC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

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 O70.4 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 5 Excludes1 notes across 3 chapters: N89.8 — Other specified noninflammatory disorders of vagina (via O70.-), N90 — Other noninflammatory disorders of vulva and perineum (via O70.-), O70.2 — Third degree perineal laceration during delivery, O71.4 — Obstetric high vaginal laceration alone (via O70.-), S31.4 — Open wound of vagina and vulva (via O70.-).

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

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 254 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 2 MS-DRGs: DRG 769 (MDC 14), DRG 776 (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):PRG026 — OB-related trauma to perineum and vulva (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 process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

O36.8191 — Decreased fetal movements, unspecified trimester, fetus 1, O36.8192 — Decreased fetal movements, unspecified trimester, fetus 2, O36.8193 — Decreased fetal movements, unspecified trimester, fetus 3, O36.8194 — Decreased fetal movements, unspecified trimester, fetus 4, O36.8195 — Decreased fetal movements, unspecified trimester, fetus 5, O36.8199 — Decreased fetal movements, unspecified trimester, other fetus, O70.20 — Third degree perineal laceration during delivery, unspecified, O70.21 — Third degree perineal laceration during delivery, IIIa, O70.22 — Third degree perineal laceration during delivery, IIIb, O70.23 — Third degree perineal laceration during delivery, IIIc, O71.00 — Rupture of uterus before onset of labor, unspecified trimester, O71.02 — Rupture of uterus before onset of labor, second trimester, O71.03 — Rupture of uterus before onset of labor, third trimester, O71.1 — Rupture of uterus during labor, O71.5 — Other obstetric injury to pelvic organs, O71.81 — Laceration of uterus, not elsewhere classified, O71.89 — Other specified obstetric trauma, O71.9 — Obstetric trauma, unspecified, O75.4 — Other complications of obstetric surgery and procedures, O75.81 — Maternal exhaustion complicating labor and delivery, +233 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (OB-related trauma to perineum and vulva).

O70.0 — First degree perineal laceration during delivery, O70.1 — Second degree perineal laceration during delivery, O70.2 — Third degree perineal laceration during delivery, O70.20 — Third degree perineal laceration during delivery, unspecified, O70.21 — Third degree perineal laceration during delivery, IIIa, O70.22 — Third degree perineal laceration during delivery, IIIb, O70.23 — Third degree perineal laceration during delivery, IIIc, O70.3 — Fourth degree perineal laceration during delivery, O70.9 — Perineal laceration during delivery, unspecified, O71.82 — Other specified trauma to perineum and vulva

Same Index main term, other category

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

O69.0 — Labor and delivery complicated by prolapse of cord (complicated, by, cord, prolapse), O69.1 — Labor and delivery complicated by cord around neck, with compression (complicated, by, cord, around neck, with compression), O69.2 — Labor and delivery complicated by other cord entanglement, with compression (complicated, by, cord, entanglement), O69.3 — Labor and delivery complicated by short cord (complicated, by, cord, short), O69.4 — Labor and delivery complicated by vasa previa (complicated, by, vasa previa), O69.5 — Labor and delivery complicated by vascular lesion of cord (complicated, by, cord, hematoma), O69.81 — Labor and delivery complicated by cord around neck, without compression (complicated, by, cord, around neck, without compression), O69.82 — Labor and delivery complicated by other cord entanglement, without compression (complicated, by, cord, entanglement, without compression), O69.89 — Labor and delivery complicated by other cord complications (umbilical cord, complicating delivery), O69.9 — Labor and delivery complicated by cord complication, unspecified (complicated, by, cord, complication), O71.0 — Rupture of uterus (spontaneous) before onset of labor (complicated, by, rupture, uterus, before labor), O71.1 — Rupture of uterus during labor (complicated, by, rupture, uterus), O71.2 — Postpartum inversion of uterus (complicated, by, inversion, uterus), O71.3 — Obstetric laceration of cervix (cervix, obstetrical trauma), O71.4 — Obstetric high vaginal laceration alone (complicated, by, laceration, rectovaginal), O71.5 — Other obstetric injury to pelvic organs (bladder, obstetrical), O71.6 — Obstetric damage to pelvic joints and ligaments (broad ligament, obstetrical trauma), O71.7 — Obstetric hematoma of pelvis (complicated, by, hematoma), O71.81 — Laceration of uterus, not elsewhere classified (complicated, by, laceration, uterus), O71.82 — Other specified trauma to perineum and vulva (complicated, by, trauma, periurethral), +194 more

Contextual Map

Every relationship of O70.4 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 O70.4 with these 5 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 · FY2026

Index entries

  • Delivery (childbirth) (labor), complicated, by, laceration (perineal), anus (sphincter)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Delivery (childbirth) (labor), complicated, by, laceration (perineal), anus (sphincter), without third degree laceration[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Tear, torn (traumatic), anus, anal (sphincter), complicating delivery, without third degree perineal laceration[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (10)

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 FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 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 — v43 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

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Anal sphincter tear complicating delivery, not associated with third degree laceration

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), 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 O70.4 in its code family, with their registry titles.

View all codes in the O70 family