Brief description of measure CMS334: Cesarean Birth: Nulliparous women with a term, singleton baby in a vertex position delivered by cesarean birth. Description of issue ​The denominator logic currently captures patients with a calculated gestational age (CGA) or estimated gestational age (EGA) >= 37 weeks. To align with a potential change to CMS1028/PC-07: Severe Obstetric Complications, the measure developer is considering expanding the denominator to include a value set containing weeks gestation diagnosis codes ranging from 37 to 42+ weeks. The measure developer proposes adding a new value set to capture encounters containing diagnoses indicative of 37+ weeks gestation that will be added to the denominator criteria. Goal of review Obtain clinical and technical feedback

Proposed solution CURRENT LOGIC: define "Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks"    "Delivery Encounter with Calculated Gestational Age Greater than or Equal to 37 Weeks"       union "Delivery Encounter with Estimated Gestational Age Greater than or Equal to 37 Weeks" PROPOSED LOGIC: Add the following value set "37 to 42 Plus Weeks Gestation" (OID: 2.16.840.1.113762.1.4.1110.68) define "Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks"     "Delivery Encounter with Calculated Gestational Age Greater than or Equal to 37 Weeks"         union "Delivery Encounter with Estimated Gestational Age Greater than or Equal to 37 Weeks"         union "Delivery Encounter with Gestational Age Greater than or Equal to 37 Weeks Based on Coding" define "Delivery Encounter with Gestational Age Greater than or Equal to 37 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 "37 to 42 Plus Weeks Gestation" ) Rationale for change ​​​The addition of ICD-10-CM diagnosis codes to capture gestational age in weeks will allow an alternate way to satisfy the measure intent, while aligning with a proposed change to CMS1028/PC-07. 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.