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  2. CQM-6318

Just a Question About PC07 eCQM ICD-10 Codes

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    • Icon: EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals
    • Resolution: Answered
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    • Carol Kunz
    • McLaren Healthcare
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      Thank you for your inquiry on CMS1028v1: Severe Obstetric Complications. The Blood Transfusion codes are found in the “Blood Transfusion” value set (2.16.840.1.113762.1.4.1029.213). These codes are separate from the other Severe Maternal Morbidity (SMM) Procedures for stratification purposes. If a patient only has a blood transfusion and no other SMM diagnoses or procedures, the patient will meet the numerator and will not meet Stratum 1. If a patient has a blood transfusion and another SMM diagnosis or procedure, the patient will meet the numerator and Stratum 1. Stratum 1 is defined as delivery hospitalizations with severe obstetric complications excluding hospitalizations where transfusion was the only severe obstetric complication. See logic below:
      Delivery Encounters with Severe Obstetric Complications

      "Delivery Encounters with Severe Obstetric Complications Diagnosis or Procedure (Excluding Blood Transfusion)"
        union "Delivery Encounters with Expiration"
        union "Delivery Encounters with Blood Transfusion"
      AND

      Stratification
      //This logic identifies a subset of the numerator population with severe obstetric complications excluding cases where transfusion was the only severe obstetric complication.

      "Stratification Encounter"
        intersect "Delivery Encounters with Severe Obstetric Complications (Excluding Blood Transfusions)"
       
      The 2 patients at your facility that met Stratum 1 should have another SMM code along with the blood transfusion code to get into Stratum 1.

      "Other immediate postpartum hemorrhage” is not a code in the Severe Maternal Morbidity value sets. However, hemorrhage associated with DIC are included in the ‘Severe Maternal Morbidity Diagnoses’ value set (2.16.840.1.113762.1.4.1029.255).
      Show
      Thank you for your inquiry on CMS1028v1: Severe Obstetric Complications. The Blood Transfusion codes are found in the “Blood Transfusion” value set (2.16.840.1.113762.1.4.1029.213). These codes are separate from the other Severe Maternal Morbidity (SMM) Procedures for stratification purposes. If a patient only has a blood transfusion and no other SMM diagnoses or procedures, the patient will meet the numerator and will not meet Stratum 1. If a patient has a blood transfusion and another SMM diagnosis or procedure, the patient will meet the numerator and Stratum 1. Stratum 1 is defined as delivery hospitalizations with severe obstetric complications excluding hospitalizations where transfusion was the only severe obstetric complication. See logic below: Delivery Encounters with Severe Obstetric Complications "Delivery Encounters with Severe Obstetric Complications Diagnosis or Procedure (Excluding Blood Transfusion)"   union "Delivery Encounters with Expiration"   union "Delivery Encounters with Blood Transfusion" AND Stratification //This logic identifies a subset of the numerator population with severe obstetric complications excluding cases where transfusion was the only severe obstetric complication. "Stratification Encounter"   intersect "Delivery Encounters with Severe Obstetric Complications (Excluding Blood Transfusions)"   The 2 patients at your facility that met Stratum 1 should have another SMM code along with the blood transfusion code to get into Stratum 1. "Other immediate postpartum hemorrhage” is not a code in the Severe Maternal Morbidity value sets. However, hemorrhage associated with DIC are included in the ‘Severe Maternal Morbidity Diagnoses’ value set (2.16.840.1.113762.1.4.1029.255).
    • CMS1028v1
    • Just need to understand this in order to validate eCQMs.

      I am trying to understand how patients fall into the numerator for PC-07 eCQM.  For the month of May I have 4 cases that met the numerator and 2 additional who have met the Stratum 1 for the numerator.  The 4 who met the numerator all show procedure 30233N1 performed (blood transfusion).  The 2 that met Stratum 1 also had this procedure performed.  I have downloaded the diagnosis and procedure files from VSAC for Severe Maternal Morbidity.  There are no codes in this file for blood transfusion.  There are also no codes for "other immediate postpartum hemorrhage", which is the reason for the blood transfusion.  So, I do not understand how these 4 are pulling into the numerator and others are not.  Per instructions on the eCQI Resource Center webpage I am using 2.16.840.1.113762.1.4.1029.255 and 2.16.840.1.113762.1.4.1029.256.  Can you please help me to understand this?  Thank you.

            JLeflore Joelencia Leflore
            ckunz01 Carol (Inactive)
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