History of Prior Myomectomy-code not excluded from PC-02 TJC measure

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    • Type: Hosp Inpt eCQMs - Hospital Inpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
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      Hello and thank you for the inquiry about CMS334/PC-02 Cesarean Birth. Myomectomy is not an exclusion for CMS334/PC-02. While extensive or complicated myomectomy can be indication for a cesarean section, these cases are rare in nulliparous patients and the code to identify prior myomectomy is too broad to only exclude extensive or complicated cases, which is why it is not included. As always, we recommend that the appropriate care should be provided based upon the provider’s assessment of patient’s needs, regardless on the impact to the performance calculation.


      Regarding the code description for O34.219, we do not see a change since this code was introduced in 2017.

      We hope this helps.
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      Hello and thank you for the inquiry about CMS334/PC-02 Cesarean Birth. Myomectomy is not an exclusion for CMS334/PC-02. While extensive or complicated myomectomy can be indication for a cesarean section, these cases are rare in nulliparous patients and the code to identify prior myomectomy is too broad to only exclude extensive or complicated cases, which is why it is not included. As always, we recommend that the appropriate care should be provided based upon the provider’s assessment of patient’s needs, regardless on the impact to the performance calculation. Regarding the code description for O34.219, we do not see a change since this code was introduced in 2017. We hope this helps.
    • Patients with C-Sections due to prior myomectomy are not being excluded from the PC-02 measure affecting NTSV CS rates.

      I was under the impression that history of prior myomectomy excluded a patient from the PC-02 measure for NTSV C-Section.  Cesarean birth is suggested prior to the onset of labor in patients who underwent an extensive or complicated myomectomy.  

      ICD-10 Code O34.219 "Maternal care for unspecified type scar from previous cesarian delivery" is listed as an exclusion for the PC-02 measure for NTSV C-Sections.    Did this code also include "/prior uterine surgery" at some point?  I have a print out from over a year ago that includes that verbiage in the code, but recently am no longer seeing that part included.  

      When requesting a coding query for patients with prior myomectomies, the coders are adding O34.29 "Maternal care due to uterine scar from other previous surgery", which is accurate, but this code is not listed as an exclusion for PC-02.

      My question is:  Is prior myomectomy considered an exclusion for PC-02 and if so, shouldn't code O34.29 be added to the exclusion list?  Otherwise, patients with CS for prior myomectomies will not be excluded from this measure.

            Assignee:
            Joelencia Leflore
            Reporter:
            Kimberly McDonald (Inactive)
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