ePC 07

XMLWordPrintable

    • Type: Hosp Inpt eCQMs - Hospital Inpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Jackie Franze
    • 260-435-2835
    • Lutheran Hospital of Indiana
    • Hide
      Thank you for your questions about CMS1028v3/PC-07, Severe Obstetric Complications. There are two numerators for the measure, one that captures delivery encounters with all severe obstetric complications (SOCs) and the other numerator captures delivery encounters where blood transfusion is not the only SOC. In other words, if a blood transfusion was the only severe obstetric complication, the delivery encounter will qualify for one numerator and not the other.

      Anemia that is present on admission is a risk adjustment variable and does not indicate if the encounter qualifies for the numerator or not.

      A patient with pneumonia would only be excluded from the denominator, and therefore not qualify for the numerator for CMS1028v3, if COVID 19 is confirmed for the encounter with a respiratory condition related to COVID 19 such as pneumonia.

      Only ICD10 codes included in the Mental Health Disorder value set (2.16.840.1.113762.1.4.1029.314) would qualify for the mental health disorder risk adjustment.
      Show
      Thank you for your questions about CMS1028v3/PC-07, Severe Obstetric Complications. There are two numerators for the measure, one that captures delivery encounters with all severe obstetric complications (SOCs) and the other numerator captures delivery encounters where blood transfusion is not the only SOC. In other words, if a blood transfusion was the only severe obstetric complication, the delivery encounter will qualify for one numerator and not the other. Anemia that is present on admission is a risk adjustment variable and does not indicate if the encounter qualifies for the numerator or not. A patient with pneumonia would only be excluded from the denominator, and therefore not qualify for the numerator for CMS1028v3, if COVID 19 is confirmed for the encounter with a respiratory condition related to COVID 19 such as pneumonia. Only ICD10 codes included in the Mental Health Disorder value set (2.16.840.1.113762.1.4.1029.314) would qualify for the mental health disorder risk adjustment.
    • CMS1028v3
    • Hospitals are being penalized for diagnosis' that are present on admission.

      If a 39 week gestational patient is admitted with present on admission (POA) Anemia, and requires blood transfusions during hospitalization, why does the hospital fail the measure since blood products are given? 

      Same with a mother with POA pneumonia.  Should the hospital fail the PC07 measure because of something present on admission?

      Also, if a patient has a dx of anxiety, is it ok to use the ICD 10 code O99.344 Other mental disorders complicating childbirth?  Most women are anxious about childbirth, why are they coded with mental disorders?

      Thank you,

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Jackie
            Votes:
            0 Vote for this issue
            Watchers:
            4 Start watching this issue

              Created:
              Updated:
              Resolved:
              Solution Posted On: