In simple words: This code indicates a tear during childbirth that goes through the skin and muscles between the vagina and anus, and also involves the ring of muscle around the anus.

Third-degree perineal laceration during delivery.This includes tears that extend through the perineal skin, vaginal mucosa, and perineal body and involve the anal sphincter. It may also involve the rectovaginal septum.Excludes1: anal sphincter tear during delivery without third-degree perineal laceration (O70.4) and perineal laceration involving anal or rectal mucosa (O70.3).

Example 1: A woman giving birth vaginally experiences a tear that involves the perineal skin, vaginal mucosa, and anal sphincter. This is documented as a third-degree perineal laceration and coded as O70.2., During a vaginal delivery, an episiotomy is performed, but the tear extends beyond the episiotomy site, involving the anal sphincter. This is coded as O70.2 as it represents a third-degree perineal laceration., A patient delivers vaginally with a tear involving the perineal skin, vaginal mucosa, and the rectovaginal septum as well as the anal sphincter. This complex laceration still falls under the classification of a third-degree tear and would be coded as O70.2.

Documentation should clearly specify the degree of the perineal laceration, involvement of the anal sphincter and/or rectovaginal septum, and any associated complications.Operative reports of the repair should also be documented.

** This code is used only on the maternal record, never on the newborn record.Additional codes may be needed to fully document the extent of the injury and any associated complications.