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  2. CQM-6130

ePC-07 Cardiomyopathy not a risk factor for Severe maternal morbidity in VSAC

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    • Resolution: Answered
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    • Jennifer Harlos
    • 9077292226
    • Alaska Native Medical Center
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      Hello and thank you for your question about CMS1028v1 Severe Obstetric Complications. You are correct, I42.7 is not currently listed in the Cardiac Disease risk variable value set. The ICD10 Coding Guidelines include "code first" instructions for code I42: code first pre-existing cardiomyopathy complicating pregnancy and puerperium (099.4x). Codes O99.411, O99.412, O99.413, O99.419 and O99.42 are listed in the Cardiac Disease value set used for risk adjustment when present on admission is yes.

      Please check with your coding department to determine if one of the O99.4x codes should be added to the patient's encounter.

      Thank you.
      Show
      Hello and thank you for your question about CMS1028v1 Severe Obstetric Complications. You are correct, I42.7 is not currently listed in the Cardiac Disease risk variable value set. The ICD10 Coding Guidelines include "code first" instructions for code I42: code first pre-existing cardiomyopathy complicating pregnancy and puerperium (099.4x). Codes O99.411, O99.412, O99.413, O99.419 and O99.42 are listed in the Cardiac Disease value set used for risk adjustment when present on admission is yes. Please check with your coding department to determine if one of the O99.4x codes should be added to the patient's encounter. Thank you.
    • CMS1028v1
    • Cardiomyopathy present on admission is not counting as a cardiac disease risk factor for severe maternal morbidity.

      We have a patient who came in for delivery who was diagnosed during her delivery admission with "acute systolic (congestive) heart failure" (Code I50.21). She had a diagnosis present on admission of "cardiomyopathy d/t drug and external agent" (Code I42.7).  I could not find I42.7 in the VSAC for ePC-07 (CMS1028v2).  Is there a reason this diagnosis code would not be considered as a preexisting condition under cardiac disease for the risk variable adjustment in ePC-07?

            JLeflore Mathematica EH eCQM Team
            jlharlos Jennifer Harlos
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