SUMMARY OF CHANGES TO SAFE DELIVERIES ROADMAP OBSTETRIC MEASURES (12/2015)
I.
Induction of Labor Measures (ICD-10 transition impact)
A gap in direct mapping of ICD-9 to ICD-10 code for induction of labor has been identified starting with
October 1, 2015 discharges. The gap misinterprets any administration of pitocin as an induction of labor
including use for augmentation of labor. The Joint Commission, ACOG and CMQCC are working with the
National ICD-10 Code Committee to rectify this. The earliest timeline for correcting this gap will be at least
several months away.
Measures Impacted:
1)
2)
3)
4)
Cesarean Delivery Rates for Full Term Inductions >=39 weeks for Nulliparous patients
Cesarean Delivery Rates for Full Term Inductions >=39 weeks for Multiparous patients
Non-Medically Indicated Full Term Inductions with Unfavorable Cervix (39-40 weeks)
Early Elective Delivery (37 to < 39 weeks) (EED)
Solution:
1) Collection of additional clinical data identifying induction of labor cases (IOL) for calculation of these
four SD Roadmap obstetrical quality measures (data may be obtained from clinical electronic medical
record, perinatal or chart reviewed data)
2) January 2016 discharges: Start date for required additional clinical IOL data for calculation of
measures. For Safe Deliveries Roadmap the additional IOL data for calculation of these measures is
encouraged for October-December 2015 discharges to avoid gaps in trending rates and will also be
needed for accurately calculating the Medicaid Quality Incentive Obstetric Measures.
II.
Transfusion Measures
Change in Types of Blood Products Collected for “Number of Units Transfused” Measures
Changes have occurred nationally to two SD “Optional” transfusion measures related to types of blood
products transfused
1) Total number of blood products transfused (CMS OB Adverse Event Measure)
Only RBCs and FFP will be counted (platelets and cryoprecipitate have been dropped)
2) Massive Blood transfusions >= 4 Units (Joint Commission Maternal Sentinel Event)
Only RBCs will be counted (FFP, platelets and cryoprecipitate have been dropped)
Potential impact of ICD-10 code changes on Rate of delivering women receiving blood transfusion measure
Coding changes in ICD10 now require identification of the location of artery or vein where the transfusion
occurred. Because the location of the transfusion is often not documented by providers, some hospitals may
experience a significant drop in coding for this procedure. Careful attention to the impact of this is
encouraged. Stay tuned for possible future plans to address this potential impact.
III. Current SD Outcome Measures that are pending ICD-10 Final versions (current versions in Draft form
from AHRQ and CMQCC)
1) Primary TSV C-section Measure (finalization of the current Draft version of “Primary CS Rate
Uncomplicated – IQI 33 from AHRQ is in process – completion is hoped for by the end of January)
2) Unexpected Newborn Complications (UNC) (finalization of draft version of UNC measure is in process –
completion is expected by the end of January from CMQCC)
IV. Outcome Measure Specification Documents are complete and will be posted to the WSHA website by
the second week of January. The documents are:






Outcome measure definition specs with ICD-10 codes FINAL 12-23-15
Appendix A1 Primary Term Singleton Vertex Cesarean Delivery Measure Specifications ICD-10_12-2315
Appendix A2 Primary TSV C-section AHRQ IQI 33_Code Specifications ICD-9 and ICD-10_12-23-15
Unexpected Newborn Complications Flow_Charts_Appendix A1 v2.3
Unexpected Newborn Complication Appendix A2_ICD9 and ICD-10_12-23-15
Summary of Changes to Safe Deliveries Roadmap Outcome and Obstetric Measures_12-2015