Safe Deliveries Roadmap Measures for WSHA -MDC …...2020/01/10 · codes blood transfusions: • Maternal blood transfusions (Safe Deliveries Roadmap measures #5a, 5c, 5d, 5e and

Safe Deliveries Roadmap Measures for WSHA-MDC and WSHA-QBS: Numerator and Denominator Specifications

(version 1-2020 update)

This document is intended for the following hospital options for source of measurement data: 1. WSHA-MDC system: Hospitals submit administrative Patient Discharge Data (PDD) and Core Clinical Maternal and Newborn Data to WSHA-

MDC system which then calculates measure rates based on definitions below and provides secure web-interface for focused supplemental chart review where indicated for selected measures. Core Clinical Maternal and Newborn data files are special names given to supplemental data files with specific data elements required for submission of data to WSHA-MDC.

2. WSHA-QBS system: Hospitals submit to WSHA-QBS System their own numerator and denominator values for each measure based on definitions below, internal hospital data analyst support and supplemental chart review data where indicated.

Summary of Changes and Updates Since Last Update (January 2019):

Measures with continued additional importance of supplemental data to identify transfusions if hospital Coding Department no longer codes blood transfusions:

• Maternal blood transfusions (Safe Deliveries Roadmap measures #5a, 5c, 5d, 5e and Severe Maternal Morbidity-transfusions measure). Measures with updated ICD-10 codes or other measure modifications:

• Severe Maternal Morbidity (with and without transfusions) among all deliveries and among two subgroups: with diagnosis of Hemorrhage; with diagnosis of Preeclampsia – CDC AIM SMM Measures; #s 11,12,13 (please refer to the most recent version on WSHA website)

• Unexpected Newborn Complications – This is a Joint Commission Perinatal Care Core Measure (PC-06) as of January 1, 2019 discharges with the measure definition specifications maintained by the Joint Commission found at: https://manual.jointcommission.org/Manual

• Maternal blood transfusions for the Severe Maternal Morbidity transfusion sub-measure: The numerator definition ICD codes are aligned with all other Safe Deliveries Maternal Transfusion measures, with the exception of Transfusions for women with Hemorrhage which excludes Sickle Cell Crisis from the numerator.

• Number and types of blood products transfused for delivering woman with a transfusion of RBCs, FFP, Platelets or Cryoprecipitate (#5e) replaced #5b Total number of blood products transfused (NOTE: #5e data is not for submission to QBS system -tracking will be maintained by hospitals)

Version January 2020 p. 2

• Newborn with severe complication among inborn term newborns with maternal shoulder dystocia diagnosis at delivery (linked mother-baby record measure) (severe complications now aligned with Joint Commission PC-06.1 Severe Unexpected Newborn complications-UNC numerator; see Joint Commission measure specifications at: https://manual.jointcommission.org/Manual )

Measure category continued change from “outcome” measure to “utilization” measure: • Long Postpartum Length of Stay for Vaginal or Cesarean Deliveries is being re-categorized to a Safe Deliveries Roadmap Utilization Measure

(6.a and 6.b.) (optional).

Retired or Optional Measures: • Maternal ICU Days per all deliveries (4b) and ICU Days for women with Preeclampsia diagnosis (9b) were retired November 2016. Maternal

admission to ICU for women with Preeclampsia diagnosis has been changed to an optional measure as these cases are already captured by Maternal admission to ICU for all delivering women.

• Severe Maternal Morbidity among delivering women with Pre-eclampsia (CMQCC Measure) was replaced in November 2016 by the new CDC-AIM Severe Maternal Morbidity with Pre-eclampsia measure.

• Maternal blood transfusions – total number of units transfused (#5b) has been retired and replaced with #5e-Number and types of blood products transfused for delivering woman with a transfusion of RBCs, FFP, Platelets or Cryoprecipitate (Not for submission to QBS system -tracking maintained by hospitals)

Other previous changes made November 2016: • The lower gestational age cut-off of <=20 weeks gestational age was removed from the relevant measures to decrease measure calculation

burden (#s 4, 5a, 5b, 5c, 6a, 6b, 9, 10). • Modifications to Induction of Labor-related and Transfusion measures were made in December 2015 due to:

1. Gaps in direct mapping of ICD-9 to ICD-10 coding for Induction of Labor: Induction of Labor Measures: continued required supplemental data field “Induced” (Yes / No) as of October 2015. The

addition of a clinical “Induced” data element enables continued calculation of the two outcome measures for CS Rates for Term Inductions of Labor in Multiparous and Nulliparous Women >= 39 Week as a data supplement bridge until the national Coding group restores ICD code specific to Induction of Labor (distinct from augmentation and AROM) which had been available with ICD-9-CM codes.

2. Updated national measure specifications for two maternal blood transfusion-related measures. This update was also provided in the December 2015 document, but is repeated here due to on-going importance: Transfusion Measures: two of the optional Safe Deliveries Roadmap transfusion measures have been aligned with national

measures from CMS and Joint Commission. Changes have occurred nationally to the blood product types captured for these measures. Washington State Safe Deliveries Roadmap made changes to these two measures to align with the national measures starting October 2015:

1) CMS OB Adverse Event Measure (original measure defined by CMS in 2014): Total number of blood products transfused per 1,000 delivering mothers. This measure has been changed to focus on RBC and FFP units only (platelets and cryoprecipitate packs will no longer counted because of variations in these unit volumes).


2) Joint Commission Maternal Sentinel Event-Massive Blood Transfusion >= 4 units: This measure is now focused on RBCs only (FFP, platelets, and cryoprecipitate packs will not be included per this Joint Commission Maternal Sentinel Event definition).

# Outcome Measure

Name

Numerator Description

Denominator Description

Definition Source Data Source Numerator Specifications Denominator Specifications

1 Nulliparous Term Singleton Vertex Cesarean Section Rate (NTSV)

All cesarean deliveries among the denominator.

Nulliparous (first birth) women > 37 weeks. Exclude: breech or transverse presentation, preterm births, fetal deaths, and multiple gestations.

Joint Commission PC-02 current for the time period.

Patient Discharge Data Plus Gestational Age at Delivery, and Parity or History of previous live birth From either: Core Clinical Maternal data OR Birth Certificate data.

Cases among the denominator who had cesarean delivery. Include: ICD-10-PCS Principal Procedure Code or ICD-10-PCS Other Procedure Codes for cesarean section as defined in Appendix A, Table 11.06: • 10D00Z0 Classical cesarean • 10D00Z1 Low cervical

cesarean • 10D00Z2 Extraperitoneal

cesarean Exclude: None

Nulliparous patients delivering live term singleton newborn in vertex presentation. This measure definition is based on the most recent Joint Commission definition and specifications. Include: ICD10 procedure codes for delivery (Appendix A, Table 11.01.1 and Singleton Outcome of delivery (Appendix A, Table 11.08) Also restrict above Deliveries to: No previous live birth or Parity = 0. Gestational Age >= 37 weeks at delivery. Exclude: ICD-10-CM Principal Diagnosis Code or ICD-10-CM Other Diagnosis Codes, for contraindications to vaginal delivery (Appendix A, Table 11.09) and for fetal demise (Appendix A, Table 11.09.1) Also Exclude: • Less than 8 yrs of age • Greater than or equal to 65 yrs

of age • Length of stay >120 days


# Outcome Measure

Name




2 Primary Term Singleton Vertex (TSV) Cesarean Section Rate


Delivering women > 37 weeks who have not had a prior cesarean section. Exclude: breech or transverse presentation, preterm births, fetal deaths, and multiple gestations.

AHRQ IQI-33 “Primary Cesarean Delivery Rate, Uncomplicated”

Patient Discharge Data Plus Gestational age at Delivery From either: Core Clinical Maternal data OR Birth Certificate data. When birth certificate data available add to exclusions: Previous c-section (# 57.7 on Birth Certificate).

Cesarean delivery among the denominator defined by either Cesarean Delivery DRG, MS-DRG or ICD-10-CM procedure codes defined by DRG codes: • 370 Cesarean w cc, • 371 Cesarean c/o cc OR MS-DRG codes: • 765 Cesarean w cc/mcc • 766 Cesarean w/o cc/mcc OR ICD-10 Cesarean Delivery Procedure Codes: • 10D00Z0 Classical cesarean • 10D00Z1 Low cervical


cesarean

Include: All deliveries, identified by DRG, MS-DRG or ICD-10 codes defined by: DRG Codes: • 370 Cesarean w cc • 371 Cesarean w/o cc • 372 Vaginal del w cc • 373 Vaginal del w/o cc • 374 Vaginal del w sterilization

&/or D&C • 375 Vaginal del w operating

room proc except steril &/or D&C

OR MS-DRG codes: • 765 Cesarean w cc/mcc • 766 Cesarean w/o cc/mcc • 767 Vaginal del w sterilization

&/or D&C • 768 Vaginal del w OR proc

except steril &/or D&C • 774 Vaginal del w cc • 775 Vaginal del w/o cc OR ICD10 Base Deliveries (see end of document for complete code list) Exclude from above Deliveries cases with: • Gestational Age < 37 weeks at

delivery • Any listed ICD-10-CM diagnosis

code for contraindication to vaginal delivery: abnormal presentation, breech, preterm, fetal death, or multiple gestation (see Appendix for detail on ICD-10 codes)


# Outcome Measure

Name




• Any listed ICD-10-CM diagnosis code for Previous Cesarean delivery (034.21 Maternal care for scar from previous cesarean delivery)

SEE TWO AHRQ APPENDIX DOCUMENTS FOR PRIMARY TERM SINGLETON VERTEX CESAREAN RATE FOR COMPLETE LIST OF CODES (AHRQ Update July 2019)

3a C-Section rate for Term Inductions of Labor in Nulliparous women >= 39 weeks gestation at delivery


Nulliparous women whose labor was induced with delivery >= 39 weeks gestation.

WSHA Safe Deliveries Roadmap

Patient Discharge Data Plus Gestational Age at delivery and Parity or History of previous live birth From either: Core Clinical Maternal data: OR Birth Certificate data and Induction of Labor (Y/N) from either Supplemental Maternal Data, internal data, chart review data or ICD10 codes

Discharges among the denominator with either: DRG, MS-DRG, or ICD-10-CM procedure codes for Cesarean delivery. DRG codes: • 370 Cesarean w cc • 371 Cesarean c/o cc OR MS-DRG codes: • 765 Cesarean w cc/mcc • 766 Cesarean w/o cc/mcc OR ICD-10 Cesarean Delivery Procedure Codes: • 10D00Z0 Classical cesarean • 10D00Z1 Low cervical


cesarean

Include all delivering women identified by ICD-10 codes ICD10 Base Deliveries (see end of document for complete code list) AND Restricted to No previous live birth or Parity = 0. Gestational Age >= 39 weeks at delivery. Induction of Labor (based on supplemental Maternal Data from internal electronic, manual data or code list for Induction of Labor at the end of this document)

3b

C-Section rate for Term Inductions of Labor in Multiparous women >= 39 weeks gestation at delivery


Multiparous women whose labor was induced with delivery >= 39 weeks gestation.


Patient Discharge Data Plus Gestational Age at delivery and Parity or History of previous live births From either: Core Clinical Maternal data

Discharges among the denominator with either: DRG or MS-DRG codes for Cesarean delivery; or Any listed ICD-10-CM procedure codes for Cesarean delivery. Cesarean Delivery DRG codes: • 370 Cesarean w cc • 371 Cesarean c/o cc OR

Include all delivering women identified by ICD-10 codes ICD10 Base Deliveries (see end of document for complete code list) AND restricted to Previous live births or Parity >=1. Gestational Age >= 39 weeks at delivery.


# Outcome Measure

Name




OR Birth Certificate data and Induction of Labor (Y/N) from either Supplemental Maternal Data, internal data, chart review data or ICD10 codes

Cesarean Delivery MS-DRG codes: • 765 Cesarean w cc/mcc • 766 Cesarean w/o cc/mcc OR ICD-10 Cesarean Delivery Procedure Codes: • 10D00Z0 Classical cesarean • 10D00Z1 Low cervical


cesarean

Induction of Labor (based on supplemental Maternal Data from internal electronic, manual data or code list for Induction of Labor at the end of this document)

4 Number of Maternal admissions to ICU per all deliveries

All maternal admissions to ICU anytime during delivery hospitalization among the denominator.

Women who delivered excluding ectopics and miscarriages


Patient Discharge Data including Billing Revenue Code data (for ICU stay).

Discharges among the denominator who had an ICU admission during their stay as identified by either: Any Revenue Charge code in Accommodations 0200 series (ICU) from PDD. OR IF REVENUE CODES NEED SUPPORT FROM SUPPLEMENTAL DATA: ICU_days > 0. For WSHA-CMDC system: data in Maternal Supplemental Clinical Data OR For WSHA-QBS system: data from other internal hospital data source.

Include all delivering women excluding ectopics and miscarriages identified by ICD-10 codes: ICD10 Base Deliveries (see end of document for complete code list)

5a Percent of delivering women who received a blood transfusion

Number of women among the denominator who received any transfusion of blood products (RBC, FFP, Platelet packs, Cryoprecipitate) identified by

Women who delivered excluding ectopics and miscarriages.


Patient Discharge Admin Data Plus If procedure codes in PDD need supplemental backup: transfusions with validation from hospital lab, blood bank, transfusion logbook OR

Among the denominator, number of patients with any ICD-10 Procedure code for specific transfusions identified by ICD-10 codes, listed at the end of this document.

Include all delivering women excluding ectopics and miscarriages identified by ICD-10 codes ICD10 Base Deliveries (see end of document for complete code list)


# Outcome Measure

Name




ICD-10-CM procedure codes from among the denominator.

optional chart review for blood transfusion data via WSHA-CMDC System Interface or WSHA-QBS: internal hospital chart review.

5c Total number of massive blood transfusions (>= 4 units RBCs) per delivering women

Number of delivering women who received >= 4 units of blood products (RBCs) per delivering women.

All women who delivered excluding ectopics and miscarriages.

WSHA Safe Deliveries Roadmap harmonized with Joint Commission Maternal Sentinel Event-Massive Transfusions

Patient Discharge Data Plus If procedure codes in PDD need supplemental backup: back-up validation from hospital lab, blood bank, transfusion logbook or chart review for entry of blood transfusion data via WSHA-CMDC Interface or WSHA-QBS: internal hospital chart review.

Among the denominator number of patients with >= 4 units RBCs transfused as identified by either: Revenue code 0380 series for transfusion blood units/types and associated Service Unit –counts OR HCPC charge code for RBCs and associated Service Units per type >= 4 units (counts) per patient. OR From Maternal Supplemental Clinical File: >= 4 units transfused for RBCs per patient. OR Optional hospital chart review via: WSHA-CMDC: secure web interface OR WSHA-QBS: other hospital chart review source. Calculated per 1,000 cases in the denominator.

Include all delivering women excluding ectopics and miscarriages identified by ICD-10 codes ICD10 Base Deliveries (see end of document for complete code list)

5d

Percent of women with hemorrhage who received a blood transfusion

Number of women among the denominator who received any transfusion of blood products (RBC, FFP, Platelet packs,

Number of delivering women excluding ectopics and miscarriages who had a hemorrhage


Patient Discharge Admin Data If ICD procedure codes are not provided by hospital coders and therefore are not present in administrative data, provide supplemental transfusion data

Among the denominator, number of patients with any ICD-10 Procedure code for specific transfusions identified by ICD-10 codes. Excludes women with a diagnosis of Sickle Cell Crisis. ICD codes for both Transfusions and Sickle Cell crisis are listed at the end of this document.

Include all delivering women excluding ectopics and miscarriages with hemorrhage identified by ICD10 codes Start with ICD10 Base Deliveries (see end of document for complete code list)


# Outcome Measure

Name




Cryoprecipitate) identified by ICD-10-CM procedure codes from among the denominator. Excludes women with a Sickle Cell Crisis diagnosis

backup, e.g. transfusions from hospital lab, blood bank, transfusion logbook OR optional chart review for blood transfusion data via WSHA-CMDC System Interface or WSHA-QBS: internal hospital chart review.

PLEASE NOTE: If ICD procedure codes are not provided by hospital coders and therefore are not present in administrative data, provide supplemental transfusion data backup, e.g. transfusions from hospital lab, blood bank, transfusion logbook OR optional chart review for blood transfusion data via WSHA-MDC System Interface or WSHA-QBS: internal hospital chart review.

Then restrict above Base deliveries to those with hemorrhage codes (see end of document for complete code list for Hemorrhage denominator)

5e Number and type of blood products transfused for delivering women with a transfusion

From among the denominator, number of units transfused by types (RBCs, FFP, Platelets, Cryoprecipitate)

Delivering women excluding ectopics and miscarriages who had any blood product transfused (RBCs, FFP, Platelets, Cryoprecipitate)


chart review for entry of blood transfusion data via WSHA-CMDC Interface, OB-COAP or tracking/maintenance/review at the hospital level (Not for submission to WSHA QBS system)

Among those patients with any blood products transfused the # and type transfused (RBCs, FFP, Platelets, Cryoprecipitate) as identified by either: Revenue code 0380 series for transfusion blood units/types and associated Service Unit –counts OR HCPC charge code for RBCs, FFP, Platelets, and Cryoprecipitate and associated Service Units per type >= 4 units (counts) per patient. OR From Maternal Supplemental Clinical File: RBCs, FFP, Platelets and Cryoprecipitate per patient. OR Optional hospital chart review via: WSHA-CMDC: secure web interface OB COAP: secure web interface or tracking and review maintained at the hospital level (Not for submission to WSHA QBS system)

Include all delivering women excluding ectopics and miscarriages with any blood product transfused (RBCs, FFP, Platelets, Cryoprecipitate) Start with ICD10 Base Deliveries (see end of document for complete code list) Then restrict to those that had a blood product transfused per Transfusion ICD procedure codes at the end of this document or per supplemental data


# Outcome Measure

Name




6a Percent of women with LOS >= 4 days from delivery to discharge per women who delivered vaginally UTILIZATION MEASURE OPTIONAL

Number of women with LOS >= 4 days from date of delivery to discharge date among the denominator.

All delivering women who delivered vaginally, excluding ectopics and miscarriages


Patient Discharge Data Plus Date of newborn birth Identified by either: Core Clinical Newborn and Maternal data OR Birth certificate data.

Discharges among the denominator with maternal length of stay from delivery day to discharge date >= 4 days.

Include all women delivering vaginally excluding ectopics and miscarriages identified by ICD-10 codes ICD10 Base Deliveries (see end of document for complete code list) then also filter out cesarean deliveries Method to filter out all but vaginal deliveries by ICD-10 codes: Step 1: Start with All Base Delivery ICD-10 codes excluding ectopics and miscarriages Step 2: Exclude cases with procedure codes for Cesarean Delivery (Table 11.06 codes): • 10D00Z0 Classical cesarean • 10D00Z1 Low cervical cesarean • 10D00Z2 Extraperitoneal

cesarean. Step 3: Cases remaining are with vaginal delivery.

6b

Percent of women with LOS >= 6 days from delivery to discharge per women who delivered by cesarean section UTILIZATION MEASURE OPTIONAL

Number of women with LOS >= 6 days from delivery to discharge among the denominator.

All delivering women who delivered by cesarean section.


Patient Discharge Data Plus Date of newborn birth Identified by either: Core Clinical Newborn and Maternal data OR Birth certificate data.

Discharges among the denominator with maternal length of stay from delivery day to discharge date >= 6 days.

Include all women delivering excluding ectopics and miscarriages identified by ICD-10 codes ICD10 Base Deliveries (see end of document for complete code list) then also filter out cesarean deliveries Then further restrict above deliveries to those who had cesarean delivery. Cesarean Delivery Procedure Codes 10D00Z0 Classical cesarean 10D00Z1 Low cervical cesarean 10D00Z2 Extraperitoneal cesarean


# Outcome Measure

Name




7 Percent of operative vaginal deliveries per all vaginal deliveries

Number of operative deliveries by forceps or vacuum from among the denominator.

Number of vaginal deliveries excluding ectopics and miscarriages


Patient Discharge Data.

From among the denominator Operative Assisted delivery with Instrument (forceps or vacuum): • 10D07Z3 Low forceps • 10D07Z4 Mid forceps • 10D07Z5 High forceps • 10D07Z6 Vacuum • 10D07Z8 Other specified or

unspecified instrument

Include all women delivering vaginally excluding ectopics and miscarriages identified by ICD10 Base Deliveries (see end of document for complete code list) then filter out cesarean deliveries Method to filter out all but vaginal deliveries by ICD-10 codes: Step 1: Start with All Base Delivery ICD-10 codes Step 2: Exclude cases with procedure codes for Cesarean Delivery: • 10D00Z0 Classical cesarean • 10D00Z1 Low cervical cesarean • 10D00Z2 Extraperitoneal

cesarean. Step 3: Cases remaining are with vaginal delivery.

8 Unexpected Newborn Complications (UNCs) per live births (Inborn) NQF 716 and Joint Commission PC measure (PC-06) Total rate per live births with two subgroups: A. Severe rate (PC-06.1) B. Moderate rate (PC-06.2)

Number of term neonates with any unexpected newborn complications (Total UNCs) among the denominator. Subgroup PC-06.1: with any severe UNCs among the denominator. Subgroup PC-06.2: with any moderate

Liveborn Inborn Term neonates w/o preexisting conditions calculated per livebirths. Exclude: preterm, <2500gm, multiple gestations, all congenital anomalies, other fetal and placental conditions, exposure to maternal drug

Joint Commission PC-06 measure. Use diagnosis and procedure codes plus supplemental data (electronic or chart review) see Joint Commission website https://manual.jointcom

Patient Discharge Data Plus linked mother-baby records, Plus birth weight, and Term/Not Term (>= 37 wks gestation). From either: Core Clinical Maternal and Newborn data OR birth certificate data.

From among the denominator: Total Complications per 100 in the denominator And two subcategories: Severe and Moderate Complications identified in hierarchical order See Joint Commission website: https://manual.jointcommission.org/Manual Severe Complications from among the denominator identified by: • Neonatal Death (by discharge

disposition-death) • Neonatal Transfer (by

discharge disposition-transfer) • Severe ICD-10 diagnosis or

procedure code) (see Joint

SEE JOINT COMMISSION MEASURE SPECIFICATIONS FOR PC-06 UNEXPECTED NEWBORN COMPLICATIONS: https://manual.jointcommission.org/Manual Include Liveborn Inborn Term neonates w/o preexisting conditions as identified by Singleton Liveborn in hospital: • >= 2500 gr BW (chart review or

supplemental file) • Term GA >= 37 weeks (chart

review or supplemental electronic linked maternal file)

From the above JC measure definition exclude: • congenital anomalies

https://manual.jointcommission.org/Manual







# Outcome Measure

Name




UNCs among the denominator.

use (prescribed or illicit).

mission.org/Manual

Commission website https://manual.jointcommission.org/Manual

Moderate Complications from among the denominator identified by: ICD-10 diagnosis and procedure codes. See Joint Commission website: https://manual.jointcommission.org/Manual

• other fetal / placental conditions or exposure to maternal drug use- prescribed or illicit

9 For women with a diagnosis of Pre-eclampsia, percent of Maternal ICU Admissions OPTIONAL

Number of delivering patients with any admission to ICU from among the denominator.

All women giving birth with any diagnosis code for preeclampsia.


Patient Discharge Data Plus Billing Revenue Code data (for ICU stay).

Among those in the denominator who had an ICU admission during their stay as identified by either: Any Revenue Charge code in Accommodations 0200 series (ICU) from PDD (Section B) OR ICU_days > 0 from Maternal Supplemental Clinical Data File.

Include all women delivering excluding ectopics and miscarriages identified by ICD-10 codes ICD10 Base Deliveries (see end of document for complete code list) AND further restrict to those with any diagnosis code for Preeclampsia, Severe preeclampsia, Eclampsia, or preeclampsia superimposed on pre-existing HTN: ICD-10-CM Codes: • O14.00 Mild to moderate pre-

eclampsia, unspecified trimester • O14.02 Mild to moderate pre-

eclampsia, second trimester • O14.03 Mild to moderate pre-

eclampsia, third trimester • O14.04 Mild to moderate pre-

eclampsia, complicating childbirth

• O14.05 Mild to moderate pre-eclampsia, complicating puerperium

• O14.90 Unspecified pre-eclampsia, unspecified trimester

• O14.92 Unspecified pre-eclampsia, second trimester






# Outcome Measure

Name




• O14.93 Unspecified pre-eclampsia, third trimester

• O14.94 Unspecified pre-eclampsia, complicating childbirth

• O14.95 Unspecified pre-eclampsia, complicating puerperium

• O11.1 Pre-existing hypertension with pre-eclampsia, first trimester

• O11.2 Pre-existing hypertension with pre-eclampsia, second trimester

• O11.3 Pre-existing hypertension with pre-eclampsia, third trimester

• O11.4 Pre-existing hypertension with pre-eclampsia, complicating childbirth

• O11.5 Pre-existing hypertension with pre-eclampsia, complicating puerperium

• O11.9 Pre-existing hypertension with pre-eclampsia, unspecified trimester

• O14.10 Severe pre-eclampsia, unspecified trimester

• O14.12 Severe pre-eclampsia, second trimester

• O14.13 Severe pre-eclampsia, third trimester

• O14.14 Severe pre-eclampsia complicating childbirth

• O14.15 Severe pre-eclampsia complicating puerperium

• O14.20 HELLP syndrome, unspecified trimester

• O14.22 HELLP syndrome, second trimester


# Outcome Measure

Name




• O14.23 HELLP syndrome, third trimester

• O14.24 HELLP syndrome, complicating childbirth

• O14.25 HELLP syndrome, complicating puerperium

• O15.00 Eclampsia in pregnancy, unspecified trimester

• O15.02 Eclampsia in pregnancy, second trimester

• O15.03 Eclampsia in pregnancy, third trimester

• O15.1 Eclampsia in labor • O15.2 Eclampsia in the

puerperium • O15.9 Eclampsia, unspecified as

to time period 11 Severe

Maternal Morbidity among delivering women

Among the denominator, all cases with any Severe Maternal Morbidity indicated by Diagnosis or Procedure (see CDC-AIM SMM Appendix for details).

All mothers during their birth admission, excluding ectopics and miscarriages (See CDC-AIM SMM Appendix for all ICD codes).

CDC AIM SMM Measure (3/20/2019)

Hospital Patient Discharge Data.

Among the denominator, number of women with Severe Maternal Morbidity (based on ICD-10 diagnosis-procedure codes. See APPENDIX for code lists): Diagnosis Codes for: • Acute Myocardial Infarction • Acute Renal Failure • Adult Respiratory Distress • Amniotic Fluid Embolism • Aneurysm • Cardiac Arrest • Disseminated Intravascular

Coagulation (DIC) • Eclampsia • Acute Heart Failure • Puerperal Cerebrovascular

Disorders • Pulmonary Edema • Severe Complications of

Anesthesia • Sepsis • Shock

Include all delivering women identified (excluding ectopics and miscarriages) by MS-DRG, or ICD-10 codes below (CDC/AIM definition) MS-DRG codes: • 765 Cesarean w cc/mcc • 766 Cesarean w/o cc/mcc • 767 Vaginal del w sterilization


except steril &/or D&C • 774 Vaginal del w cc • 775 Vaginal del w/o cc OR ICD-10-CM Delivery codes • PLEASE SEE CDC-AIM SMM

APPENDIX ON WSHA WEBSITE FOR DETAILED LIST OF SEVERE MATERNAL MORBIDITY ICD-CODES FOR BOTH NUMERATOR AND DENOMINATOR. ALSO SEE ICD CODES LIST FOR


# Outcome Measure

Name




• Sickle Cell Crisis • Air and Thrombotic Embolism Procedure Codes for: • Transfusion • Conversion of Cardiac Rhythm • Hysterectomy • Temporary Tracheostomy • Ventilation

TRANSFUSIONS AT THE END OF THIS DOCUMENT – SMM TRANSFUSION MEASURE NUMERATOR FOR SAFE DELIVERIES IS NOW ALIGNED WITH OTHER SAFE DELIVERIES TRANSFUSION MEASURES (WITH THE EXCEPTION OF MEASURE 5D “TRANSFUSION AMONG WOMEN WITH HEMORRHAGE” WHICH EXCLUDES WOMEN WITH SICKLE CELL CRISIS FROM THE NUMERATOR)

12 Severe Maternal Morbidity among delivering women with Hemorrhage

Among the denominator, all cases with any Severe Maternal Morbidity Code (see CDC-AIM SMM Appendix).

All mothers during their birth admission, excluding ectopics and miscarriages, meeting one of the following criteria: Presence of an Abruption, Previa, Antepartum, intrapartum or postpartum hemorrhage diagnosis code

CDC AIM SMM Measure (3/20/2019)


Among the denominator number of women with Severe Maternal Morbidity (based on ICD-10 diagnosis-procedure codes): Diagnosis Codes for: • Acute Myocardial Infarction • Acute Renal Failure • Adult Respiratory Distress • Amniotic Fluid Embolism • Aneurysm • Cardiac Arrest • Disseminated Intravascular



Anesthesia • Sepsis • Shock • Sickle Cell Crisis • Air and Thrombotic Embolism Procedure Codes for: • Transfusion



except steril &/or D&C • 774 Vaginal del w cc • 775 Vaginal del w/o cc OR ICD-10-CM Delivery codes (see Appendix) AND Any code for presence of: • Abruption • Previa • Antepartum hemorrhage

diagnosis code • Transfusion procedure code

without a sickle cell crisis diagnosis code


# Outcome Measure

Name




• Conversion of Cardiac Rhythm • Hysterectomy • Temporary Tracheostomy • Ventilation

• Postpartum hemorrhage diagnosis code

PLEASE SEE CDC-AIM SMM APPENDIX ON WSHA WEBSITE FOR DETAILED LIST OF SEVERE MATERNAL MORBIDITY ICD-CODES FOR BOTH NUMERATOR AND DENOMINATOR. ALSO SEE ICD CODES LIST FOR TRANSFUSIONS AT THE END OF THIS DOCUMENT – SMM TRANSFUSION MEASURE NUMERATOR FOR SAFE DELIVERIES IS NOW ALIGNED WITH OTHER SAFE DELIVERIES TRANSFUSION MEASURES (WITH THE EXCEPTION OF MEASURE 5D “TRANSFUSION AMONG WOMEN WITH HEMORRHAGE” WHICH EXCLUDES WOMEN WITH SICKLE CELL CRISIS FROM THE NUMERATOR)

13 Severe Maternal Morbidity among delivering women with a diagnosis of pre-eclampsia, or superimposed preeclampsia

Among the denominator, all cases with any Severe Maternal Morbidity Code (see CDC-AIM SMM Appendix).

All mothers during their birth admission, excluding ectopics and miscarriages, with one of the following diagnosis codes: • Severe

Preeclampsia • Eclampsia • Preeclampsia

superimposed on pre-existing hypertension

•

CDC AIM SMM Measure


Among the denominator, number of women with Severe Maternal Morbidity (based on ICD-10 diagnosis-procedure codes): Diagnosis Codes for: • Acute Myocardial Infarction • Acute Renal Failure • Adult Respiratory Distress • Amniotic Fluid Embolism • Aneurysm • Cardiac Arrest • Disseminated Intravascular



Anesthesia



except steril &/or D&C • 774 Vaginal del w cc • 775 Vaginal del w/o cc OR ICD-10-CM Delivery codes (see Appendix) AND Any code for: • Severe Preeclampsia


# Outcome Measure

Name




• Sepsis • Shock • Sickle Cell Crisis • Air and Thrombotic Embolism Procedure Codes for: • Transfusion • Conversion of Cardiac Rhythm • Hysterectomy • Temporary Tracheostomy Ventilation

• Eclampsia • Preeclampsia superimposed on

pre-existing hypertension PLEASE SEE CDC-AIM SMM APPENDIX ON WSHA WEBSITE FOR DETAILED LIST OF SEVERE MATERNAL MORBIDITY ICD-CODES FOR BOTH NUMERATOR AND DENOMINATOR. ALSO SEE ICD CODES LIST FOR TRANSFUSIONS AT THE END OF THIS DOCUMENT – SMM TRANSFUSION MEASURE NUMERATOR FOR SAFE DELIVERIES IS NOW ALIGNED WITH OTHER SAFE DELIVERIES TRANSFUSION MEASURES (WITH THE EXCEPTION OF MEASURE 5D “TRANSFUSION AMONG WOMEN WITH HEMORRHAGE” WHICH EXCLUDES WOMEN WITH SICKLE CELL CRISIS FROM THE NUMERATOR)

14a

Maternal Chorio-amnionitis or newborn affected by chorio-amnionitis among all deliveries (two subgroups: a) from Primary TSV deliveries and b) from Non-Primary TSV deliveries)

From among the denominator, maternal chorio-amnionitis and/or newborn affected by chorio-amnionitis.

Women who delivered excluding ectopics and miscarriages. (two subgroups: a) from Primary TSV >= 37 weeks without prior cesarean delivery and b) from Non-Primary TSV delivery).

Maternal Data Center

Patient Discharge Data Plus Gestational age at Delivery From either: Core Clinical Maternal data OR Birth Certificate data. When birth certificate data available add to exclusions: Previous c-section (# 57.7 on Birth Certificate).

• FOR NUMERATOR SPECIFICATIONS PLEASE SEE APPENDIX FOR CHORIOAMNIONITIS

See ICD10 Base Deliveries (see end of document for complete code list) MEASURE CALCULATED FOR TWO DENOMINATOR SUBGROUPS:

A) PRIMARY TSV DELIVERIES WITHOUT HISTORY OF PRIOR CESAREAN (SEE MEASURE #2 DEFINITION)

B) NON-PRIMARY TSV DELIVERIES (ALL DELIVERIES THAT WERE NOT AMONG SUBGROUP A

FOR SUBGROUP A) PRIMARY TSV DELIVERIES: Exclude cases with: • Gestational Age < 37 weeks at

delivery • Any listed ICD-10-CM diagnosis

code for contraindication to


# Outcome Measure

Name




vaginal delivery: abnormal presentation, breech, preterm, fetal death, or multiple gestation (see Appendix for detail on ICD-10 codes)

• Any listed ICD-10-CM diagnosis code for Previous Cesarean delivery. SEE TWO APPENDIX DOCUMENTS ON WSHA WEBSITE FOR PRIMARY TERM SINGLETON VERTEX CESAREAN RATE FOR COMPLETE LIST OF CODES.

FOR SUBGROUP B) NON-PRIMARY TSV DELIVERIES: All deliveries excluding those that were among Subgroup A (Primary TSV Deliveries).

14b

Newborns affected by chorioamnionitis or born to a mother with chorioamnionitis among all liveborn newborns

From among the denominator, newborns affected by chorioamnionitis or born to a mother with chorioamnionitis

All liveborn newborns

• FOR NUMERATOR SPECIFICATIONS PLEASE SEE APPENDIX FOR CHORIOAMNIONITIS

FOR DENOMINATOR PLEASE SEE APPENDIX FOR CHORIOAMNIONITIS

15 Newborn with Severe Complication among term inborn newborns with shoulder dystocia delivery

From among the denominator, newborns with Severe Unexpected Newborn Complication

All term inborns linked with maternal delivery record who had a shoulder dystocia with delivery (GA >= 37 weeks or newborn BW >= 2000g).

Maternal Data Center

Patient Discharge Data Plus linked mother-baby records, Plus birth weight, and Gestational age at delivery from either: Core Clinical Maternal and Newborn data OR birth certificate data.

Severe Unexpected Newborn Complications from among the denominator identified by: • Neonatal Death (by discharge

disposition-death) • Neonatal Transfer (by

discharge disposition-transfer) • Severe ICD-10 diagnosis or

procedure code) The numerator specifications are aligned with the Severe Unexpected Newborn Complications maintained by the Joint Commission: See

Include: All inborn newborns linked with maternal delivery, record. Inborn Newborn diagnoses codes: PLEASE SEE APPENDIX FOR SHOULDER DYSTOCIA WITH NEWBORN SEVERE COMPLICATIONS SPECIFICATIONS ON WSHA WEBSITE for detailed list of ICD-9-CM and ICD-10-CM codes.


# Outcome Measure

Name




Joint Commission website https://manual.jointcommission.org/Manual for these specifications

RETIRED Measures: 4b

Number of maternal ICU DAYS per 100 deliveries (RETIRED)

Number of ICU days among the denominator.

Women with delivery at any gestational age, calculated per 100 delivering women.


Patient Discharge Data including Billing Revenue Code data (for ICU stay).

Among the denominator number of maternal ICU days as identified by either: Number of unit charge codes associated with Revenue code in Accommodations 0200 series (ICU) from PDD OR Number of ICU days from Maternal Supplemental Clinical Data OR OPTIONAL chart review via: WSHA-CMDC: secure chart review web interface OR WSHA-QBS: other hospital chart review source. Calculated per 100 Discharges among the denominator.

Include all delivering women identified by DRG, MS-DRG or ICD-10 codes below: DRG Codes: • 370 Cesarean w cc • 371 Cesarean w/o cc • 372 Vaginal del w cc • 373 Vaginal del w/o cc • 374 Vaginal del w sterilization


except steril &/or D&C OR MS-DRG codes: • 765 Cesarean w cc/mcc • 766 Cesarean w/o cc/mcc • 767 Vaginal del w sterilization


except steril &/or D&C • 774 Vaginal del w cc • 775 Vaginal del w/o cc OR Delivery ICD-10 codes: Joint Commission Appendix A: Table 11.01.1.

5b

Total number of blood products transfused per delivering women (RETIRED)

Number of blood product units transfused from among the denominator.

Women who delivered excluding ectopics and miscarriages


Patient Discharge Admin Data Plus If procedure codes in PDD need supplemental backup: transfusions with validation from hospital lab, blood

Among the denominator number of blood products transfused by each type and total: RBCs and FFP. Identified by either: Revenue code 0380 series for transfusion blood units/types and associated Service Unit –counts OR

Include all delivering women excluding ectopics and miscarriages identified by ICD-10-CM codes ICD10 Base Deliveries (see end of document for complete code list)




# Outcome Measure

Name




bank, transfusion logbook OR optional chart review for blood transfusion data via WSHA-CMDC System Interface or WSHA-QBS: internal hospital chart review.

HCPC charge code for type and associated Service Units counts OR From Maternal Supplemental Clinical File: number of units transfused for RBCs, FFP, Platelets and Cryoprecipitate OR OPTIONAL chart review via: WSHA-CMDC: secure chart review web interface OR WSHA-QBS: other hospital chart review source. • Calculated per 1,000 cases in

the denominator. Note for Measures 3.a., 3.b., 4.a., 4.b., 5.a., 5.b., 5.c., 5.d, 8, 9, 11, 12, 13: These measures are intended for collaborative and similar QI projects that utilize time series designs (same hospital before and after). These are not designed or validated to be used as inter-hospital quality measures (comparing hospital A to B or to compare practices of individual clinicians). These are metrics that will need some case mix/risk adjustment with validation work before any comparisons between hospitals can be done, but they are valuable to hospitals in trending their own data.

TRANSFUSION CODES: Numerator Specifications for Measures 5a, 5d, and 5e: women who received a blood transfusion. List of ICD-10 Procedures codes for specific transfusions: 30230H0 Transfusion of Autologous Whole Blood into Peripheral Vein, Open Approach 30230K0 Transfusion of Autologous Frozen Plasma into Peripheral Vein, Open Approach 30230L0 Transfusion of Autologous Fresh Plasma into Peripheral Vein, Open Approach 30230M0 Transfusion of Autologous Plasma Cryoprecipitate into Peripheral Vein, Open Approach 30230N0 Transfusion of Autologous Red Blood Cells into Peripheral Vein, Open Approach 30230P0 Transfusion of Autologous Frozen Red Cells into Peripheral Vein, Open Approach 30230R0 Transfusion of Autologous Platelets into Peripheral Vein, Open Approach 30230T0 Transfusion of Autologous Fibrinogen into Peripheral Vein, Open Approach 30230H1 Transfusion of Nonautologous Whole Blood into Peripheral Vein, Open Approach 30230K1 Transfusion of Nonautologous Frozen Plasma into Peripheral Vein, Open Approach


30230L1 Transfusion of Nonautologous Fresh Plasma into Peripheral Vein, Open Approach 30230M1 Transfusion of Nonautologous Plasma Cryoprecipitate into Peripheral Vein, Open

Approach 30230N1 Transfusion of Nonautologous Red Blood Cells into Peripheral Vein, Open Approach 30230P1 Transfusion of Nonautologous Frozen Red Cells into Peripheral Vein, Open Approach 30230R1 Transfusion of Nonautologous Platelets into Peripheral Vein, Open Approach 30230T1 Transfusion of Nonautologous Fibrinogen into Peripheral Vein, Open Approach 30233H0 Transfusion of Autologous Whole Blood into Peripheral Vein, Percutaneous Approach 30233K0 Transfusion of Autologous Frozen Plasma into Peripheral Vein, Percutaneous Approach 30233L0 Transfusion of Autologous Fresh Plasma into Peripheral Vein, Percutaneous Approach 30233M0 Transfusion of Autologous Plasma Cryoprecipitate into Peripheral Vein, Percutaneous

Approach 30233N0 Transfusion of Autologous Red Blood Cells into Peripheral Vein, Percutaneous Approach 30233P0 Transfusion of Autologous Frozen Red Cells into Peripheral Vein, Percutaneous Approach 30233R0 Transfusion of Autologous Platelets into Peripheral Vein, Percutaneous Approach 30233T0 Transfusion of Autologous Fibrinogen into Peripheral Vein, Percutaneous Approach 30233H1 Transfusion of Nonautologous Whole Blood into Peripheral Vein, Percutaneous Approach 30233K1 Transfusion of Nonautologous Frozen Plasma into Peripheral Vein, Percutaneous

Approach 30233L1 Transfusion of Nonautologous Fresh Plasma into Peripheral Vein, Percutaneous Approach 30233M1 Transfusion of Nonautologous Plasma Cryoprecipitate into Peripheral Vein, Percutaneous

Approach 30233N1 Transfusion of Nonautologous Red Blood Cells into Peripheral Vein, Percutaneous

Approach 30233P1 Transfusion of Nonautologous Frozen Red Cells into Peripheral Vein, Percutaneous

Approach 30233R1 Transfusion of Nonautologous Platelets into Peripheral Vein, Percutaneous Approach 30233T1 Transfusion of Nonautologous Fibrinogen into Peripheral Vein, Percutaneous Approach 30240H0 Transfusion of Autologous Whole Blood into Central Vein, Open Approach 30240K0 Transfusion of Autologous Frozen Plasma into Central Vein, Open Approach 30240L0 Transfusion of Autologous Fresh Plasma into Central Vein, Open Approach 30240M0 Transfusion of Autologous Plasma Cryoprecipitate into Central Vein, Open Approach 30240N0 Transfusion of Autologous Red Blood Cells into Central Vein, Open Approach 30240P0 Transfusion of Autologous Frozen Red Cells into Central Vein, Open Approach 30240R0 Transfusion of Autologous Platelets into Central Vein, Open Approach 30240T0 Transfusion of Autologous Fibrinogen into Central Vein, Open Approach


30240H1 Transfusion of Nonautologous Whole Blood into Central Vein, Open Approach 30240K1 Transfusion of Nonautologous Frozen Plasma into Central Vein, Open Approach 30240L1 Transfusion of Nonautologous Fresh Plasma into Central Vein, Open Approach 30240M1 Transfusion of Nonautologous Plasma Cryoprecipitate into Central Vein, Open Approach 30240N1 Transfusion of Nonautologous Red Blood Cells into Central Vein, Open Approach 30240P1 Transfusion of Nonautologous Frozen Red Cells into Central Vein, Open Approach 30240R1 Transfusion of Nonautologous Platelets into Central Vein, Open Approach 30240T1 Transfusion of Nonautologous Fibrinogen into Central Vein, Open Approach 30243H0 Transfusion of Autologous Whole Blood into Central Vein, Percutaneous Approach 30243K0 Transfusion of Autologous Frozen Plasma into Central Vein, Percutaneous Approach 30243L0 Transfusion of Autologous Fresh Plasma into Central Vein, Percutaneous Approach 30243M0 Transfusion of Autologous Plasma Cryoprecipitate into Central Vein, Percutaneous

Approach 30243N0 Transfusion of Autologous Red Blood Cells into Central Vein, Percutaneous Approach 30243P0 Transfusion of Autologous Frozen Red Cells into Central Vein, Percutaneous Approach 30243R0 Transfusion of Autologous Platelets into Central Vein, Percutaneous Approach 30243T0 Transfusion of Autologous Fibrinogen into Central Vein, Percutaneous Approach 30243H1 Transfusion of Nonautologous Whole Blood into Central Vein, Percutaneous Approach 30243K1 Transfusion of Nonautologous Frozen Plasma into Central Vein, Percutaneous Approach 30243L1 Transfusion of Nonautologous Fresh Plasma into Central Vein, Percutaneous Approach 30243M1 Transfusion of Nonautologous Plasma Cryoprecipitate into Central Vein, Percutaneous

Approach 30243N1 Transfusion of Nonautologous Red Blood Cells into Central Vein, Percutaneous Approach 30243P1 Transfusion of Nonautologous Frozen Red Cells into Central Vein, Percutaneous Approach 30243R1 Transfusion of Nonautologous Platelets into Central Vein, Percutaneous Approach 30243T1 Transfusion of Nonautologous Fibrinogen into Central Vein, Percutaneous Approach

Base Deliveries Code Specifications ICD-10 Diagnoses Z37.0 Single live birth Z37.1 Single stillbirth Z37.2 Twins, both liveborn Z37.3 Twins, one liveborn and one stillborn Z37.4 Twins, both stillborn Z37.50 Multiple births, unspecified, all liveborn


Z37.51 Triplets, all liveborn Z37.52 Quadruplets, all liveborn Z37.53 Quintuplets, all liveborn Z37.54 Sextuplets, all liveborn Z37.59 Other multiple births, all liveborn Z37.60 Multiple births, unspecified, some liveborn Z37.61 Triplets, some liveborn Z37.62 Quadruplets, some liveborn Z37.63 Quintuplets, some liveborn Z37.64 Sextuplets, some liveborn Z37.69 Other multiple births, some liveborn Z37.7 Other multiple births, all stillborn Z37.9 Outcome of delivery, unspecified O80 Encounter for full-term uncomplicated delivery O82 Encounter for cesarean delivery without indication ICD-10 Procedures 10D00Z0 Extraction of Products of Conception, Classical, Open Approach 10D00Z1 Extraction of Products of Conception, Low Cervical, Open Approach 10D00Z2 Extraction of Products of Conception, Extraperitoneal, Open Approach 10D07Z3 Extraction of Products of Conception, Low Forceps, Via Natural or Artificial Opening 10D07Z4 Extraction of Products of Conception, Mid Forceps, Via Natural or Artificial Opening 10D07Z5 Extraction of Products of Conception, High Forceps, Via Natural or Artificial Opening 10D07Z6 Extraction of Products of Conception, Vacuum, Via Natural or Artificial Opening 10D07Z7 Extraction of Products of Conception, Internal Version, Via Natural or Artificial Opening 10D07Z8 Extraction of Products of Conception, Other, Via Natural or Artificial Opening 10E0XZZ Delivery of Products of Conception, External Approach Then Exclude deliveries with these codes (e.g. miscarriages, ectopics) ICD-10 Diagnoses O00.0 Abdominal pregnancy O00.00 Abdominal pregnancy without intrauterine pregnancy O00.01 Abdominal pregnancy with intrauterine pregnancy O00.1 Tubal pregnancy O00.10 Tubal pregnancy without intrauterine pregnancy O00.101 Right tubal pregnancy without intrauterine pregnancy O00.102 Left tubal pregnancy without intrauterine pregnancy


O00.109 Unspecified tubal pregnancy without intrauterine pregnancy O00.11 Tubal pregnancy with intrauterine pregnancy O00.111 Right tubal pregnancy with intrauterine pregnancy O00.112 Left tubal pregnancy with intrauterine pregnancy O00.119 Unspecified tubal pregnancy with intrauterine pregnancy O00.2 Ovarian pregnancy O00.20 Ovarian pregnancy without intrauterine pregnancy O00.201 Right ovarian pregnancy without intrauterine pregnancy O00.202 Left ovarian pregnancy without intrauterine pregnancy O00.209 Unspecified ovarian pregnancy without intrauterine pregnancy O00.21 Ovarian pregnancy with intrauterine pregnancy O00.211 Right ovarian pregnancy with intrauterine pregnancy O00.212 Left ovarian pregnancy without intrauterine pregnancy O00.219 Unspecified ovarian pregnancy with intrauterine pregnancy O00.8 Other ectopic pregnancy O00.80 Other ectopic pregnancy without intrauterine pregnancy O00.81 Other ectopic pregnancy with intrauterine pregnancy O00.9 Ectopic pregnancy, unspecified O00.90 Unspecified ectopic pregnancy without intrauterine pregnancy O00.91 Unspecified ectopic pregnancy with intrauterine pregnancy O01.0 Classical hydatidiform mole O01.1 Incomplete and partial hydatidiform mole O01.9 Hydatidiform mole, unspecified O02.0 Blighted ovum and nonhydatidiform mole O02.1 Missed abortion O02.81 Inappropriate change in quantitative human chorionic gonadotropin (hCG) in early pregnancy O02.89 Other abnormal products of conception O02.9 Abnormal product of conception, unspecified O03.0 Genital tract and pelvic infection following incomplete spontaneous abortion O03.1 Delayed or excessive hemorrhage following incomplete spontaneous abortion O03.2 Embolism following incomplete spontaneous abortion O03.30 Unspecified complication following incomplete spontaneous abortion O03.31 Shock following incomplete spontaneous abortion O03.32 Renal failure following incomplete spontaneous abortion O03.33 Metabolic disorder following incomplete spontaneous abortion


O03.34 Damage to pelvic organs following incomplete spontaneous abortion O03.35 Other venous complications following incomplete spontaneous abortion O03.36 Cardiac arrest following incomplete spontaneous abortion O03.37 Sepsis following incomplete spontaneous abortion O03.38 Urinary tract infection following incomplete spontaneous abortion O03.39 Incomplete spontaneous abortion with other complications O03.4 Incomplete spontaneous abortion without complication O03.5 Genital tract and pelvic infection following complete or unspecified spontaneous abortion O03.6 Delayed or excessive hemorrhage following complete or unspecified spontaneous abortion O03.7 Embolism following complete or unspecified spontaneous abortion O03.80 Unspecified complication following complete or unspecified spontaneous abortion O03.81 Shock following complete or unspecified spontaneous abortion O03.82 Renal failure following complete or unspecified spontaneous abortion O03.83 Metabolic disorder following complete or unspecified spontaneous abortion O03.84 Damage to pelvic organs following complete or unspecified spontaneous abortion O03.85 Other venous complications following complete or unspecified spontaneous abortion O03.86 Cardiac arrest following complete or unspecified spontaneous abortion O03.87 Sepsis following complete or unspecified spontaneous abortion O03.88 Urinary tract infection following complete or unspecified spontaneous abortion O03.89 Complete or unspecified spontaneous abortion with other complications O03.9 Complete or unspecified spontaneous abortion without complication O04.5 Genital tract and pelvic infection following (induced) termination of pregnancy O04.6 Delayed or excessive hemorrhage following (induced) termination of pregnancy O04.7 Embolism following (induced) termination of pregnancy O04.80 (Induced) termination of pregnancy with unspecified complications O04.81 Shock following (induced) termination of pregnancy O04.82 Renal failure following (induced) termination of pregnancy O04.83 Metabolic disorder following (induced) termination of pregnancy O04.84 Damage to pelvic organs following (induced) termination of pregnancy O04.85 Other venous complications following (induced) termination of pregnancy O04.86 Cardiac arrest following (induced) termination of pregnancy O04.87 Sepsis following (induced) termination of pregnancy O04.88 Urinary tract infection following (induced) termination of pregnancy O04.89 (Induced) termination of pregnancy with other complications O07.0 Genital tract and pelvic infection following failed attempted termination of pregnancy


O07.1 Delayed or excessive hemorrhage following failed attempted termination of pregnancy O07.2 Embolism following failed attempted termination of pregnancy O07.30 Failed attempted termination of pregnancy with unspecified complications O07.31 Shock following failed attempted termination of pregnancy O07.32 Renal failure following failed attempted termination of pregnancy O07.33 Metabolic disorder following failed attempted termination of pregnancy O07.34 Damage to pelvic organs following failed attempted termination of pregnancy O07.35 Other venous complications following failed attempted termination of pregnancy O07.36 Cardiac arrest following failed attempted termination of pregnancy O07.37 Sepsis following failed attempted termination of pregnancy O07.38 Urinary tract infection following failed attempted termination of pregnancy O07.39 Failed attempted termination of pregnancy with other complications O07.4 Failed attempted termination of pregnancy without complication O08.0 Genital tract and pelvic infection following ectopic and molar pregnancy O08.1 Delayed or excessive hemorrhage following ectopic and molar pregnancy O08.2 Embolism following ectopic and molar pregnancy O08.3 Shock following ectopic and molar pregnancy O08.4 Renal failure following ectopic and molar pregnancy O08.5 Metabolic disorders following an ectopic and molar pregnancy O08.6 Damage to pelvic organs and tissues following an ectopic and molar pregnancy O08.7 Other venous complications following an ectopic and molar pregnancy O08.81 Cardiac arrest following an ectopic and molar pregnancy O08.82 Sepsis following ectopic and molar pregnancy O08.83 Urinary tract infection following an ectopic and molar pregnancy O08.89 Other complications following an ectopic and molar pregnancy O08.9 Unspecified complication following an ectopic and molar pregnancy Z39.0 Encounter for care and examination of mother immediately after delivery Z39.1 Encounter for care and examination of lactating mother Z39.2 Encounter for routine postpartum follow-up ICD-10 Procedures 10A00ZZ Abortion of Products of Conception, Open Approach 10A03ZZ Abortion of Products of Conception, Percutaneous Approach 10A04ZZ Abortion of Products of Conception, Percutaneous Endoscopic Approach 10A07Z6 Abortion of Products of Conception, Vacuum, Via Natural or Artificial Opening 10A07ZW Abortion of Products of Conception, Laminaria, Via Natural or Artificial Opening


10A07ZX Abortion of Products of Conception, Abortifacient, Via Natural or Artificial Opening 10A07ZZ Abortion of Products of Conception, Via Natural or Artificial Opening 10A08ZZ Abortion of Products of Conception, Via Natural or Artificial Opening Endoscopic

Induction of Labor Diagnosis and Procedure Codes: O61.0 Failed medical induction of labor O61.1 Failed instrumental induction of labor O61.8 Other failed induction of labor O61.9 Failed induction of labor, unspecified 3E033VJ Introduction of Other Hormone into Peripheral Vein, Percutaneous Approach 0U7C7DZ Dilation of Cervix with Intraluminal Device, Via Natural or Artificial Opening 0U7C7ZZ Dilation of Cervix, Via Natural or Artificial Opening 3E0DXGC Introduction of Other Therapeutic Substance into Mouth and Pharynx, External

Approach 3E0P3VZ Introduction of Hormone into Female Reproductive, Percutaneous Approach 3E0P7GC Introduction of Other Therapeutic Substance into Female Reproductive, Via Natural or

Artificial Opening 3E0P7VZ Introduction of Hormone into Female Reproductive, Via Natural or Artificial Opening 10900ZC Drainage of Amniotic Fluid, Therapeutic from Products of Conception, Open Approach 10903ZC Drainage of Amniotic Fluid, Therapeutic from Products of Conception, Percutaneous

Approach 10904ZC Drainage of Amniotic Fluid, Therapeutic from Products of Conception, Percutaneous

Endoscopic Approach 10907ZC Drainage of Amniotic Fluid, Therapeutic from Products of Conception, Via Natural or

Artificial Opening 10908ZC Drainage of Amniotic Fluid, Therapeutic from Products of Conception, Via Natural or

Artificial Opening Endoscopic 3E033VJ Introduction of Other Hormone into Peripheral Vein, Percutaneous Approach 0U7C7DZ Dilation of Cervix with Intraluminal Device, Via Natural or Artificial Opening 0U7C7ZZ Dilation of Cervix, Via Natural or Artificial Opening 3E0DXGC Introduction of Other Therapeutic Substance into Mouth and Pharynx, External

Approach 3E0P3VZ Introduction of Hormone into Female Reproductive, Percutaneous Approach 3E0P7GC Introduction of Other Therapeutic Substance into Female Reproductive, Via Natural or

Artificial Opening 3E0P7VZ Introduction of Hormone into Female Reproductive, Via Natural or Artificial Opening


Hemorrhage Code Specifications IC0-10 Code ICD-10 Description

Diagnosis Codes

O44.10 Complete placenta previa with hemorrhage, unspecified trimester O44.12 Complete placenta previa with hemorrhage, second trimester O44.13 Complete placenta previa with hemorrhage, third trimester O44.30 Partial placenta previa with hemorrhage, unspecified trimester O44.32 Partial placenta previa with hemorrhage, second trimester O44.33 Partial placenta previa with hemorrhage, third trimester O44.50 Low lying placenta with hemorrhage, unspecified trimester O44.52 Low lying placenta with hemorrhage, second trimester O44.53 Low lying placenta with hemorrhage, third trimester O45.002 Premature separation of placenta with coagulation defect, unspecified, second trimester O45.003 Premature separation of placenta with coagulation defect, unspecified, third trimester O45.009 Premature separation of placenta with coagulation defect, unspecified, unspecified trimester O45.012 Premature separation of placenta with afibrinogenemia, second trimester O45.013 Premature separation of placenta with afibrinogenemia, third trimester O45.019 Premature separation of placenta with afibrinogenemia, unspecified trimester O45.022 Premature separation of placenta with disseminated intravascular coagulation, second trimester O45.023 Premature separation of placenta with disseminated intravascular coagulation, third trimester O45.029 Premature separation of placenta with disseminated intravascular coagulation, unspecified trimester O45.092 Premature separation of placenta with other coagulation defect, second trimester O45.093 Premature separation of placenta with other coagulation defect, third trimester O45.099 Premature separation of placenta with other coagulation defect, unspecified trimester O45.8X2 Other premature separation of placenta, second trimester O45.8X3 Other premature separation of placenta, third trimester O45.8X9 Other premature separation of placenta, unspecified trimester O45.90 Premature separation of placenta, unspecified, unspecified trimester O45.92 Premature separation of placenta, unspecified, second trimester O45.93 Premature separation of placenta, unspecified, third trimester O46.002 Antepartum hemorrhage with coagulation defect, unspecified, second trimester O46.003 Antepartum hemorrhage with coagulation defect, unspecified, third trimester


O46.009 Antepartum hemorrhage with coagulation defect, unspecified, unspecified trimester O46.012 Antepartum hemorrhage with afibrinogenemia, second trimester O46.013 Antepartum hemorrhage with afibrinogenemia, third trimester O46.019 Antepartum hemorrhage with afibrinogenemia, unspecified trimester O46.022 Antepartum hemorrhage with disseminated intravascular coagulation, second trimester O46.023 Antepartum hemorrhage with disseminated intravascular coagulation, third trimester O46.029 Antepartum hemorrhage with disseminated intravascular coagulation, unspecified trimester O46.092 Antepartum hemorrhage with other coagulation defect, second trimester O46.093 Antepartum hemorrhage with other coagulation defect, third trimester O46.099 Antepartum hemorrhage with other coagulation defect, unspecified trimester O46.8X2 Other antepartum hemorrhage, second trimester O46.8X3 Other antepartum hemorrhage, third trimester O46.8X9 Other antepartum hemorrhage, unspecified trimester O46.92 Antepartum hemorrhage, unspecified, second trimester O46.93 Antepartum hemorrhage, unspecified, third trimester O43.212 Placenta accreta, second trimester O43.213 Placenta accreta, third trimester O43.219 Placenta accreta, unspecified trimester O43.222 Placenta increta, second trimester O43.223 Placenta increta, third trimester O43.229 Placenta increta, unspecified trimester O43.232 Placenta percreta, second trimester O43.233 Placenta percreta, third trimester O43.239 Placenta percreta, unspecified trimester O72.0 Third-stage hemorrhage O72.1 Other immediate postpartum hemorrhage O72.2 Delayed and secondary postpartum hemorrhage O72.3 Postpartum coagulation defects

Sickle Cell Crisis Code Specifications IC0-10 Code ICD-10 Description

Diagnosis Codes

D57.00 Hb-SS disease with crisis, unspecified


D57.01 Hb-SS disease with acute chest syndrome D57.02 Hb-SS disease with splenic sequestration D57.211 Sickle-cell/Hb-C disease with acute chest syndrome D57.212 Sickle-cell/Hb-C disease with splenic sequestration D57.219 Sickle-cell/Hb-C disease with crisis, unspecified D57.411 Sickle-cell thalassemia with acute chest syndrome D57.412 Sickle-cell thalassemia with splenic sequestration D57.419 Sickle-cell thalassemia with crisis, unspecified D57.811 Other sickle-cell disorders with acute chest syndrome D57.812 Other sickle-cell disorders with splenic sequestration D57.819 Other sickle-cell disorders with crisis, unspecified

Documents

Safe Deliveries Roadmap Measures for WSHA -MDC …...2020/01/10 · codes blood transfusions: • Maternal blood transfusions (Safe Deliveries Roadmap measures #5a, 5c, 5d, 5e and