The following response was provided to a ticket directly addressing the most recent comments: https://oncprojectracking.healthit.gov/support/browse/CQM-2387

Code Z.33.1 is a secondary code only for use when the pregnancy is in no way complicating the reason for visit. This code is not appropriate to include as an exclusion, as in these cases the primary diagnosis may be a condition that places the patient at risk for VTE.

The remaining Z.34 supervision codes make sense to add to the Obstetrics exclusion, as they indicate a patient had a pregnancy encounter, and these codes are always first-listed and are not to be used with any other code from the OB chapter.

We intend to add the Z34 codes you suggest. We will not add Z.33.1 for the reason stated.

Would someone provide an update on the status of my question. I have many users of eCQMs waiting for the response. Thank you.

Is it possible to have an update regarding the rationale for not including these codes in the OB set that would exclude these OB patients from the VTE measures? Thank you

We are receiving questions regarding missing ICD-10-CM codes from the OB value set for CMS108v5. The hospitals are asking why the following codes are not included in the value set:
Z331 Pregnant state, incidental
Z3400 Encounter for supervision of normal first pregnancy, unspecified trimester
Z3401 Encounter for supervision of normal first pregnancy, first trimester
Z3402 Encounter for supervision of normal first pregnancy, second trimester
Z3403 Encounter for supervision of normal first pregnancy, third trimester
Z3480 Encounter for supervision of other normal pregnancy, unspecified trimester

Z3481 Encounter for supervision of other normal pregnancy, first trimester
Z3482 Encounter for supervision of other normal pregnancy, second trimester
Z3483 Encounter for supervision of other normal pregnancy, third trimester
Z3490 Encounter for supervision of normal pregnancy, unspecified, unspecified trimester
Z3491 Encounter for supervision of normal pregnancy, unspecified, first trimester
Z3492 Encounter for supervision of normal pregnancy, unspecified, second trimester
Z3493 Encounter for supervision of normal pregnancy, unspecified, third trimester

If these codes are not missing, what is the rationale for not including these codes.
Thank you

You would need to check with your vendor to see how you have the ICD10 codes being pulled to see where it pulls the diagnosis. The obstetric value set provides ICD10 codes on what qualifies to exclude the patient. If the patient has given birth, it is expected that the patient is then evaluated​ for prophylaxis.

Shouldn't the patient be excluded from the VTE measures at the outset for an obstetric admission diagnosis of ICD-10CM O80 Encounter for full-term uncomplicated delivery or is the exclusion criteria reliant on final diagnoses?

Please clarify the following:
Is the only ICD-10 code that is excluded from the obstetrics population Z37.0? If so, does this mean that ALL patients who deliver a single live birth during encounter must be evaluated for prophylaxis?

Please clarify the timing for this as a patient may be in labor for a substantial window of time before delivery occurs. When would the "clock" begin for these patients?

Once a patient has given birth, the expectation is that they are evaluated for prophylaxis therefore code Z37.0 would be excluded.

For CMS108v4 and CMS108v5 there are ICD-10 codes missing from the value sets. We have obstetric patients qualifying for VTE-1 eCQM. ICD-10-CM Code not included in the 2.16.840.1.113883.3.117.1.7.1.263 value set is Z37.0 Single Live Birth

I would also like the answer to this question. Our vendor is stating that they are because not all the OB ICD10 codes are included in the measure exclusion.

We are asking for verification that obstetric patients are not included in VTE 1 and VTE 2.

Can you please provide additional information regarding your question? Thank you.