O65.3 ICD-10-CM Code: Obstructed labor due to pelvic outlet and mid-cavity contraction
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FY 2026 Apr update / Pregnancy, childbirth and the puerperium (O00-O9A) / Complications of labor and delivery (O60-O77)
O65.3
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceObstructed labor due to pelvic outlet and mid-cavity contraction
Labor obstruction caused by narrowing in the lower part of the mother's pelvis or the middle section where the baby must descend.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
MappedHCC 208
Varies by metal level
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for O65.3 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for O65.3 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for O65.3 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for O65.3 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for O65.3 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for O65.3 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for O65.3 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is O65.3 an HCC code?
No. O65.3 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
- Code
- O65.3
- Description
- Obstructed labor due to pelvic outlet and mid-cavity contraction
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
O65.3 is the ICD-10-CM diagnosis code for obstructed labor due to pelvic outlet and mid-cavity contraction. Labor obstruction caused by narrowing in the lower part of the mother's pelvis or the middle section where the baby must descend. O65.3 sits in the ICD-10-CM chapter for pregnancy, childbirth and the puerperium (o00-o9a), within the section covering complications of labor and delivery (o60-o77).
O65.3 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Distinguish between outlet contraction (lower pelvis) and mid-cavity contraction; both are included in this code.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for O65.3 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Distinguish between outlet contraction (lower pelvis) and mid-cavity contraction; both are included in this code
- •Ensure documentation specifies which area of the pelvis is contracted to support accurate coding