​We recommend you review the most recent version of the eCQM specification, which is updated based on the most recent literature and evidence. Documentation of spontaneous rupture of membranes without onset of labor should be taken at face value according to ACOG. The 2013 ACOG definition of Preterm Rupture of Membranes (PROM) is rupture of membranes before the onset of labor. Membrane rupture that occurs before 37 weeks of gestation is referred to as preterm PROM. Membrane rupture that occurs at 37 weeks of gestation or later is referred to as term PROM. In 2014, ACOG re-named premature rupture of membranes to pre-labor rupture of membranes in order to further clarify the meaning of PROM. We consider ACOG an authoritative source. Based on the ACOG definition, we have included ICD-10 and SNOMED codes in the following Value set: "Conditions Possibly Justifying Elective Delivery Prior to 39 Weeks Gestation," which is a part of the Denominator Exclusion. Lack of documentation is an organizational level issue and should be worked out at the organizational level. We do not make changes to specifications due to organizational level issues.

Per the following numerator statement, “AND NOT: "Physical Exam, Performed: Labor" <= 24 hour(s) starts before start of "Occurrence A of Procedure, Performed: Cesarean Birth" patients who have a C-section must have documentation of onset of labor date/time. Because this statement is written as an “AND NOT” lack of documentation of labor will result in the patient passing this criteria and could ultimately lead to a fallout. Additionally, this statement does not consider patients with SROM that are not in labor. Please note, when a patient has spontaneous rupture of membranes, best practice guidelines state that the patient should be induced to deliver within 24 hours. Per the 2013 version of this eCQM, the algorithm allows for the patient to have SROM and a C-section without being in labor. Per our Women’s and Children’s service line, we are able to verify that this scenario does occur and should be considered for evaluation within this measure. Please see the attached screenshot of the 2013 measure (eCQM-113 v.2).