Brief description of measure CMS1028: Severe Obstetric Complications: Patients with severe obstetric complications which occur during the inpatient delivery hospitalization. Description of issue "​​The ""Risk Variable Preterm Birth"" definition's purpose is to risk adjust patients who experience a preterm birth defined as gestational age of >= 20 weeks and <= 36 weeks.  The logic currently captures patients with a calculated gestational age (CGA) or estimated gestational age (EGA) in this range or, if neither of those values are available, it will look for an ICD-10-CM diagnosis of preterm birth.  However, it was brought to the attention of the measure developer that if a patient is not in the denominator the patient will not be risk adjusted. In order to be included in the denominator, a patient must have a CGA or an EGA >= 20 weeks; the denominator logic does not allow for a diagnosis indication of gestational age. Therefore, as the logic currently stands, a patient with a null CGA and null EGA and with a diagnosis in the ""Preterm Birth"" value set, will not be risk adjusted, as a patient without CGA and EGA would not be captured in the denominator. Pilot testing showed that almost all patients had a CGA or EGA, thus this should not have a big impact on risk adjustment.  However, at this time we are considering an alternate way to capture gestational age by adding a value set containing weeks gestation diagnosis codes ranging from 20 to 42+ weeks. This will assure that patients with null CGA and null EGA and with a diagnosis indicating ""Preterm Birth"" will be risk adjusted.  The measure developer proposes adding a new value set to capture encounters containing diagnoses indicative of 20+ weeks gestation that will be added to the denominator criteria. " Goal of review Obtain clinical and technical feedback

Proposed solution CURRENT LOGIC: define "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation"    "Delivery Encounters with Calculated Gestational Age Greater than or Equal to 20 Weeks"      union "Delivery Encounters with Estimated Gestational Age Assessment Greater than or Equal to 20 Weeks" PROPOSED LOGIC: Add the following value set "20 to 42 Plus Weeks Gestation" (OID: 2.16.840.1.113762.1.4.1110.67) define "Delivery Encounters At Greater than or Equal to 20 Weeks Gestation"     "Delivery Encounters with Calculated Gestational Age Greater than or Equal to 20 Weeks"        union "Delivery Encounters with Estimated Gestational Age Assessment Greater than or Equal to 20 Weeks"        union "Delivery Encounters with Gestational Age Greater than or Equal to 20 Weeks Based on Coding" define "Delivery Encounters with Gestational Age Greater than or Equal to 20 Weeks Based on Coding"     PCMaternal."Delivery Encounter with Age Range" DeliveryEncounter        let CGA: PCMaternal."CalculatedGestationalAge" ( DeliveryEncounter ),              EGA: PCMaternal."LastEstimatedGestationalAge" ( DeliveryEncounter )            where CGA is null               and EGA is null               and exists ( DeliveryEncounter.diagnoses EncounterDiagnoses where EncounterDiagnoses.code in "20 to 42 Plus Weeks Gestation"            and EncounterDiagnoses.presentOnAdmissionIndicator in "Present On Admission = Yes or Exempt" ) Rationale for change ​Currently, cases with a diagnosis code of "Preterm Birth" are not meeting the denominator and therefore are not eligible for risk adjustment. Adding a valueset based on ICD-10-CM weeks gestation codes will place the patient in the denominator if calculated and estimated gestational age are not available.