COMPLICATIONS OCCURRING MAINLY IN THE COURSE OF LABOR AND DELIVERY (660-669)

• The following fifth-digit subclassification is for use with categories 660-669 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
• 660 Obstructed labor
  • Requires fifth digit; valid digits are in [brackets] under each code. See beginning of section 660-669 for definitions.
  • 660.0 Obstruction caused by malposition of fetus at onset of labor
  • [0,1,3] Any condition classifiable to 652, causing obstruction during labor
    • Use additional code from 652.0-652.9 to identify condition
  • 660.1 Obstruction by bony pelvis
  • [0,1,3] Any condition classifiable to 653, causing obstruction during labor
    • Use additional code from 653.0-653.9 to identify condition
  • 660.2 Obstruction by abnormal pelvic soft tissues
  • [0,1,3] Prolapse of anterior lip of cervix
    • Any condition classifiable to 654, causing obstruction during labor
    • Use additional code from 654.0-654.9 to identify condition
  • 660.3 Deep transverse arrest and persistent occipitoposterior position
  • [0,1,3]
  • 660.4 Shoulder (girdle) dystocia
  • [0,1,3] Impacted shoulders
  • 660.5 Locked twins
  • [0,1,3]
  • 660.6 Failed trial of labor, unspecified
  • [0,1,3] Failed trial of labor, without mention of condition or suspected condition
  • 660.7 Failed forceps or vacuum extractor, unspecified
  • [0,1,3] Application of ventouse or forceps, without mention of condition
  • 660.8 Other causes of obstructed labor
  • [0,1,3]
  • 660.9 Unspecified obstructed labor
  • [0,1,3] Dystocia:
    • NOS
    • fetal NOS
    • maternal NOS
• 661 Abnormality of forces of labor
  • Requires fifth digit; valid digits are in [brackets] under each code. See beginning of section 660-669 for definitions.
  • 661.0 Primary uterine inertia
  • [0,1,3] Failure of cervical dilation
    • Hypotonic uterine dysfunction, primary
    • Prolonged latent phase of labor
  • 661.1 Secondary uterine inertia
  • [0,1,3] Arrested active phase of labor
    • Hypotonic uterine dysfunction, secondary
  • 661.2 Other and unspecified uterine inertia
  • [0,1,3] Atony of uterus
    • Desultory labor
    • Irregular labor
    • Poor contractions
    • Slow slope active phase of labor
  • 661.3 Precipitate labor
  • [0,1,3]
  • 661.4 Hypertonic, incoordinate, or prolonged uterine contractions
  • [0,1,3] Cervical spasm
    • Contraction ring (dystocia)
    • Dyscoordinate labor
    • Hourglass contraction of uterus
    • Hypertonic uterine dysfunction
    • Incoordinate uterine action
    • Retraction ring (Bandl's) (pathological)
    • Tetanic contractions
    • Uterine dystocia NOS
    • Uterine spasm
  • 661.9 Unspecified abnormality of labor
  • [0,1,3]
• 662 Long labor
  • Requires fifth digit; valid digits are in [brackets] under each code. See beginning of section 660-669 for definitions.
  • 662.0 Prolonged first stage
  • [0,1,3]
  • 662.1 Prolonged labor, unspecified
  • [0,1,3]
  • 662.2 Prolonged second stage
  • [0,1,3]
  • 662.3 Delayed delivery of second twin, triplet, etc.
  • [0,1,3]
• 663 Umbilical cord complications
  • Requires fifth digit; valid digits are in [brackets] under each code. See beginning of section 660-669 for definitions.
  • 663.0 Prolapse of cord
  • [0,1,3] Presentation of cord
  • 663.1 Cord around neck, with compression
  • [0,1,3] Cord tightly around neck
  • 663.2 Other and unspecified cord entanglement, with compression
  • [0,1,3] Entanglement of cords of twins in mono-amniotic sac
    • Knot in cord (with compression)
  • 663.3 Other and unspecified cord entanglement, without mention of compression
  • [0,1,3]
  • 663.4 Short cord
  • [0,1,3]
  • 663.5 Vasa previa
  • [0,1,3] Velamentous insertion of umbilical cord
  • 663.6 Vascular lesions of cord
  • [0,1,3] Bruising of cord
    • Hematoma of cord
    • Thrombosis of vessels of cord
  • 663.8 Other umbilical cord complications
  • [0,1,3]
  • 663.9 Unspecified umbilical cord complication
  • [0,1,3]
• 664 Trauma to perineum and vulva during delivery
  • Requires fifth digit; valid digits are in [brackets] under each code. See beginning of section 660-669 for definitions.
  • Includes: damage from instruments
    • that from extension of episiotomy
  • 664.0 First-degree perineal laceration
  • [0,1,4] Perineal laceration, rupture, or tear involving:
    • fourchette
    • hymen
    • labia
    • skin
    • vagina
    • vulva
  • 664.1 Second-degree perineal laceration
  • [0,1,4] Perineal laceration, rupture, or tear (following episiotomy) involving:
    • pelvic floor
    • perineal muscles
    • vaginal muscles
    • Excludes: that involving anal sphincter (664.2)
  • 664.2 Third-degree perineal laceration
  • [0,1,4] Perineal laceration, rupture, or tear (following episiotomy) involving:
    • anal sphincter
    • rectovaginal septum
    • sphincter NOS
    • Excludes: that with anal or rectal mucosal laceration (664.3)
  • 664.3 Fourth-degree perineal laceration
  • [0,1,4] Perineal laceration, rupture, or tear as classifiable to 664.2 and involving also:
    • anal mucosa
    • rectal mucosa
  • 664.4 Unspecified perineal laceration
  • [0,1,4] Central laceration
  • 664.5 Vulval and perineal hematoma
  • [0,1,4]
  • 664.8 Other specified trauma to perineum and vulva
  • [0,1,4]
  • 664.9 Unspecified trauma to perineum and vulva
  • [0,1,4]
• 665 Other obstetrical trauma
  • Requires fifth digit; valid digits are in [brackets] under each code. See beginning of section 660-669 for definitions.
  • Includes: damage from instruments
  • 665.0 Rupture of uterus before onset of labor
  • [0,1,3]
  • 665.1 Rupture of uterus during labor
  • [0,1] Rupture of uterus NOS
  • 665.2 Inversion of uterus
  • [0,2,4]
  • 665.3 Laceration of cervix
  • [0,1,4]
  • 665.4 High vaginal laceration
  • [0,1,4] Laceration of vaginal wall or sulcus without mention of perineal laceration
  • 665.5 Other injury to pelvic organs
  • [0,1,4] Injury to:
    • bladder
    • urethra
  • 665.6 Damage to pelvic joints and ligaments
  • [0,1,4] Avulsion of inner symphyseal cartilage
    • Damage to coccyx
    • Separation of symphysis (pubis)
  • 665.7 Pelvic hematoma
  • [0-2,4] Hematoma of vagina
  • 665.8 Other specified obstetrical trauma
  • [0-4]
  • 665.9 Unspecified obstetrical trauma
  • [0-4]
• 666 Postpartum hemorrhage
  • Requires fifth digit; valid digits are in [brackets] under each code. See beginning of section 660-669 for definitions.
  • 666.0 Third-stage hemorrhage
  • [0,2,4] Hemorrhage associated with retained, trapped, or adherent placenta
    • Retained placenta NOS
  • 666.1 Other immediate postpartum hemorrhage
  • [0,2,4] Hemorrhage within the first 24 hours following delivery of placenta
    • Postpartum hemorrhage (atonic) NOS
  • 666.2 Delayed and secondary postpartum hemorrhage
  • [0,2,4] Hemorrhage:
    • after the first 24 hours following delivery
    • associated with retained portions of placenta or membranes
    • Postpartum hemorrhage specified as delayed or secondary
    • Retained products of conception NOS, following delivery
  • 666.3 Postpartum coagulation defects
  • [0,2,4] Postpartum:
    • afibrinogenemia
    • fibrinolysis
• 667 Retained placenta without hemorrhage
  • Requires fifth digit; valid digits are in [brackets] under each code. See beginning of section 660-669 for definitions.
  • 667.0 Retained placenta without hemorrhage
  • [0,2,4] Placenta accreta without hemorrhage
    • Retained placenta:
      • NOS without hemorrhage
      • total without hemorrhage
  • 667.1 Retained portions of placenta or membranes, without hemorrhage
  • [0,2,4] Retained products of conception following delivery, without hemorrhage
• 668 Complications of the administration of anesthetic or other sedation in labor and delivery
  • Use additional code(s) to further specify complication
  • Requires fifth digit; valid digits are in [brackets] under each code. See beginning of section 660-669 for definitions.
  • Includes: complications arising from the administration of a general or local anesthetic, analgesic, or other sedation in labor and delivery
  • Excludes: reaction to spinal or lumbar puncture (349.0)
    • spinal headache (349.0)
  • 668.0 Pulmonary complications
  • [0-4] Inhalation [aspiration] of stomach contents or secretions following anesthesia or other sedation in labor or delivery
    • Mendelson's syndrome following anesthesia or other sedation in labor or delivery
    • Pressure collapse of lung following anesthesia or other sedation in labor or delivery
  • 668.1 Cardiac complications
  • [0-4] Cardiac arrest or failure following anesthesia or other sedation in labor and delivery
  • 668.2 Central nervous system complications
  • [0-4] Cerebral anoxia following anesthesia or other sedation in labor and delivery
  • 668.8 Other complications of anesthesia or other sedation in labor and delivery
  • [0-4]
  • 668.9 Unspecified complication of anesthesia and other sedation
  • [0-4]
• 669 Other complications of labor and delivery, not elsewhere classified
  • Requires fifth digit; valid digits are in [brackets] under each code. See beginning of section 660-669 for definitions.
  • 669.0 Maternal distress
  • [0-4] Metabolic disturbance in labor and delivery
  • 669.1 Shock during or following labor and delivery
  • [0-4] Obstetric shock
  • 669.2 Maternal hypotension syndrome
  • [0-4]
  • 669.3 Acute renal failure following labor and delivery
  • [0,2,4]
  • 669.4 Other complications of obstetrical surgery and procedures
  • [0-4] Cardiac:
    • arrest following cesarean or other obstetrical surgery or procedure, including delivery NOS
    • failure following cesarean or other obstetrical surgery or procedure, including delivery NOS
    • Cerebral anoxia following cesarean or other obstetrical surgery or procedure, including delivery NOS
    • Excludes: complications of obstetrical surgical wounds (674.1-674.3)
  • 669.5 Forceps or vacuum extractor delivery without mention of indication
  • [0,1] Delivery by ventouse, without mention of indication
  • 669.6 Breech extraction, without mention of indication
  • [0,1]
    • Excludes: breech delivery NOS (652.2)
  • 669.7 Cesarean delivery, without mention of indication
  • [0,1]
  • 669.8 Other complications of labor and delivery
  • [0-4]
  • 669.9 Unspecified complication of labor and delivery
  • [0-4]