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Type: EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals
Resolution: Answered
Priority: Blocker
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Thank you for your questions about CMS1028v3 Severe Obstetric Complications.

To address your first question, imagine a Venn diagram in which the area of overlap is "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions Only." One circle represents "Delivery Encounters with Severe Obstetric Complications," and the other circle represents "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions." As you pointed out, both include:

Delivery Encounters with Severe Obstetric Complications Diagnosis or Procedure Excluding Blood Transfusion.
Delivery Encounters with Expiration.
Only one definition has Delivery Encounters with Blood Transfusion and therefore those cases are not included in the numerator population.

To clarify for the second question, the numerator population for Population Criteria 2 excludes delivery encounters in which blood transfusion is the only severe obstetric complication (SOC). There could be cases in that numerator population that have a blood transfusion and additional SOC diagnoses, or SOC procedures.

Once the numerator population is identified, the numerator exclusions are addressed. From the numerator population, exclude delivery encounters that include both an encounter diagnosis of placenta increta or placenta percreta (usually found on the EHR Problem List) and a blood transfusion or hysterectomy. These excluded cases may have a diagnosis for placenta increta or percreta with a blood transfusion, plus a hysterectomy or additional SOC diagnosis or procedure that kept them in the numerator until the numerator exclusions are considered.

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Thank you for your questions about CMS1028v3 Severe Obstetric Complications. To address your first question, imagine a Venn diagram in which the area of overlap is "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions Only." One circle represents "Delivery Encounters with Severe Obstetric Complications," and the other circle represents "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions." As you pointed out, both include: Delivery Encounters with Severe Obstetric Complications Diagnosis or Procedure Excluding Blood Transfusion. Delivery Encounters with Expiration. Only one definition has Delivery Encounters with Blood Transfusion and therefore those cases are not included in the numerator population. To clarify for the second question, the numerator population for Population Criteria 2 excludes delivery encounters in which blood transfusion is the only severe obstetric complication (SOC). There could be cases in that numerator population that have a blood transfusion and additional SOC diagnoses, or SOC procedures. Once the numerator population is identified, the numerator exclusions are addressed. From the numerator population, exclude delivery encounters that include both an encounter diagnosis of placenta increta or placenta percreta (usually found on the EHR Problem List) and a blood transfusion or hysterectomy. These excluded cases may have a diagnosis for placenta increta or percreta with a blood transfusion, plus a hysterectomy or additional SOC diagnosis or procedure that kept them in the numerator until the numerator exclusions are considered.
2025 Reporting Period EH/CAH eCQMs:

CMS1028v3

Hi Team,

We have few queries for CMS1028v3 for Population criteria2.

Consider below statements from Numerator:

Numerator
"Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions Only"

Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions Only
"Delivery Encounters with Severe Obstetric Complications"
intersect "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions"

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"

Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions
"Delivery Encounters with Severe Obstetric Complications Diagnosis or Procedure Excluding Blood Transfusion"
union "Delivery Encounters with Expiration"

Query 1:

Delivery Encounters with Expiration criteria is a part of both criteria's-
Delivery Encounters with Severe Obstetric Complications
Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions

However, population criteria2 checks for Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions Only.
Kindly help us with the interpretation.

Consider below statements from Numerator exclusion
Numerator Exclusion 2 SOC Excluding Blood Transfusions Only with Hysterectomy or Blood Transfusion with Placenta Increta or Placenta Percreta Without Additional SOC
"SOC Excluding Blood Transfusions Only with Hysterectomy or Blood Transfusion with Placenta Increta or Placenta Percreta Without Additional SOC"
SOC Excluding Blood Transfusions Only with Hysterectomy or Blood Transfusion with Placenta Increta or Placenta Percreta Without Additional SOC
( "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions Only" SOCExcludingTransfusion
where exists ( SOCExcludingTransfusion.diagnoses EncounterDiagnoses
where EncounterDiagnoses.code in "Placenta Increta or Percreta"
)
and ( exists "Delivery Encounters with Blood Transfusion"
or exists "Delivery Encounters with Hysterectomy"
)
)
//The following logic keeps encounter in the numerator if there is an additional SOC besides Blood Transfusion or Hysterectomy

except ( ( "Delivery Encounters with Severe Obstetric Complications Excluding Blood Transfusions Only" SOCExcludingTransfusion
where ( "POAIsNoOrUTD"(SOCExcludingTransfusion).code in "Severe Maternal Morbidity Diagnoses" )
)
union "Delivery Encounters with Cardiac Conversion, Tracheostomy or Ventilation Procedures"
union "Delivery Encounters with Expiration"
)
Query 2:
As per above logic, We need to check Placenta Increta or Percreta in absence of blood transfusion(SOCExcludingTransfusion).But further the logic also specifies to check for Delivery Encounters with Blood Transfusion in AND logic. How should EncounterDiagnoses-"Placenta Increta or Percreta" be checked?
Should it be checked in presence or absence of blood transfusion?

Request you to assist us on the above query as our client deliverables are dependent on it.

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