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.
  • 651.0 Twin pregnancy
  • [0,1,3]
  • 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]
  • 651.8 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
  • 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] Conjoined twins
    • Fetal:
      • ascites
      • hydrops
      • myelomeningocele
      • sacral teratoma
      • tumor
  • 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)
  • 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] Fibrosis of perineum
    • Persistent hymen
    • Previous surgery to perineum or vulva
    • Rigid perineum
    • Tumor of vulva
    • Excludes: 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]
    • Excludes: fetal distress in labor and delivery due to drug administration (656.3)
  • 655.6 Suspected damage to fetus from radiation
  • [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 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.
  • 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] Abnormal fetal:
    • acid-base balance
    • heart rate or rhythm
    • Fetal:
      • acidemia
      • bradycardia
      • tachycardia
    • Meconium in liquor
  • 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] Lithopedian
  • 656.9 Unspecified fetal and placental problem
  • [0,1,3]
• 657 Polyhydramnios
• [0,1,3]
  • 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
  • Hydramnios
• 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)
  • 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 indiciations 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]
    • Excludes: supervision only, in pregnancy (V23.8)
  • 659.6 Other advanced maternal age
  • [0,1,3]
    • Excludes: elderly primigravida (659.5)
  • 659.8 Other specified indications for care or intervention related to labor and delivery
  • [0,1,3]
  • 659.9 Unspecified indication for care or intervention related to labor and delivery
  • [0,1,3]