aetna smart compare ob/gyn 2022 - full designation methodology

Proprietary

1

Aetna Smart Compare™

OB/GYN Physician Designation

Measurement Methodology

2022

Proprietary

2

Proprietary

3

Contents Background on Obstetrics/Gynecology(OB/GYN) designations ............................................................ 5

How we evaluate OB/GYNs .......................................................................................................................... 5

1. Volume .................................................................................................................................................... 7

2. Effectiveness: Episodes efficiency ....................................................................................................... 7

3. Clinical quality ...................................................................................................................................... 12

Appendix A: Empirical Bayesian approach ............................................................................................... 22

Appendix B: Hospital referral regions (HRRs) ........................................................................................... 23

Appendix C: ETG code list with condition category ................................ Error! Bookmark not defined.

Appendix D: Health profile database (HPD) conditions .......................................................................... 31

Appendix E: OB/GYN effectiveness (episode) performance evaluation example ............................... 33

Appendix F: Clinical quality performance evaluation example .............................................................. 35

Appendix G: High Risk Pregnancy Diagnosis ........................................................................................... 38

Proprietary

4

Proprietary

5

Background on Obstetrics/Gynecology (OB/GYN) designations Aetna® is one of the oldest and largest national insurers. That experience gives us a unique

opportunity to help transform health care. We believe that a better care system is more transparent

and consumer-focused, and it recognizes physicians for their clinical quality and effective use of

health care resources.

We are developing provider designations to support reaching this vision.

The OB/GYN designation identifies OB/GYN practices, participating in an Aetna commercial plan,

that provide high-quality effective care to patients 18 years of age or older based on recognized

industry measures. This OG/GYN designation will give our members more information to help them

choose an OB/GYN practice for themselves and their families. OB/GYN practices will be measured

annually.

Aetna Smart Compare designations from commercial plans are limited to self-insured plans in California and Texas. Members excluded from the program will not see designations in Aetna’s secure member portal, and they will not receive designations through other communication channels.

How we evaluate OB/GYNs The OB/GYN designation is organized around three categories of measures:

• Volume, the number of episodes of care attributed to a practice.

• Effectiveness, the outcome, and efficiency of treatment decisions is analyzed and scored in 2

sub-categories: obstetrics conditions and gynecologic conditions.

• Clinical quality, compliance with selected clinical guidelines, is analyzed and

scored in 2 sub-categories: obstetrics conditions and gynecologic conditions.

We measure these categories separately. Provider practices that meet the volume threshold for each

population can earn up to two summary designations for each patient population — one for

effectiveness and one for clinical quality. Summary designations are awarded by aggregating

sub-category scores.

Table 1 illustrates the scoring for each designation.

Table 1 – Full list of sub-category scoring for obstetrics and gynecology

Commercial adults

Summary Detailed

Effectiveness OB episodes of care

Gyn episodes of care

Clinical

quality

OB quality

Gyn quality

• Sub-category scores are aggregated

into summary designations for clinical

quality and effectiveness

• Only summary designations will be

displayed through our digital search

tools.

Proprietary

7

1. Volume

Physician practices must see enough members for us to evaluate them. And have reliable results

that truly reflect a physicians’ practice-patterns.

For effectiveness: Only OB/GYN practices with at least >5 pregnancy non outlier episodes or >10

non outlier gynecology episodes for episode dates of 1/1/2018 through 12/31/2019 are eligible to

receive designations for that patient population.

For quality: We only use quality measures that have at least 3 members in the denominator in our

evaluation. An OB/GYN practice must have at least 3 valid measures to receive a quality designation.

Only general OB/GYN physician will be eligible for this designation. General OB/GYN physicians are

physicians with at least 1 claim with a general OB/GYN diagnoses and below a certain threshold for

specialize diagnose. See Appendix F for full list of diagnoses and specific thresholds.

High-cost claimants (HCC) are removed from the analysis. If a member has claim costs (total allowed

amount) per year > 99 percentile in either 2018 or 2019, the member is tagged as an HCC member

and is excluded from the analysis. Below is the HCC threshold by claim year (report period), line of

business and population:

Time Period Line of

Business Age Group

HCC threshold

(99_percentile)

2018 CP Adults $80,125

2019 CP Adults $82,895

2. Effectiveness: Episodes efficiency “Episode of care” is a methodology to assist in understanding medical cost and utilization. An episode

of care for a member represents diagnostic and treatment services over time for a specific health

condition. All relevant costs and utilization of services for the specific condition are rolled up into a

single entity for analysis. An episode of care spans services from the onset of symptoms until treatment

is complete; for chronic conditions the episode lasts one year

We use Optum Symmetry® Episode Treatment Groups® (ETG®) software version 9.4 illness

classification system to build episodes of care data in the Aetna® Data Warehouse.

The ETG technology is a form of "grouper" software. The software accepts health care claims (service

line detail) and returns the ETG value, along with other patient information. The grouper software

combines all relevant doctor, hospital, pharmacy, and ancillary testing claims data together. It then

creates episodes of illness or surgery that are clinically defined and identified by ETG codes for analytic

purposes.

There are many variables that can affect the use of health care resources for a condition such as

severity of illness, age, and comorbid conditions. To account for these variations in resource use, a case-

mix-adjusted “expected allowed amount” is created for each member specific ETG that is attributed to

a physician group. This case-mix-adjusted expected allowed amount is then compared to the actual

allowed amount for that episode of care. There can be variation in efficiency indexes over time for

practices that have met the initial volume threshold but have relatively lower numbers. To avoid

attributing random variation to a practice pattern the statistical significance of a provider group’s

efficiency score is evaluated at p ≤ .10 significance level.

Proprietary

8

We evaluate the efficiency of OB/GYN’s using episode conditions that an OB/GYN physician typically

manages and where they had the most visits with that patient while managing that condition or they

performed a surgery for that patient. At least >5 pregnancy valid non-outlier episodes or >10

gynecology valid non-outlier episodes are required for each population to be eligible for a

designation.

An ETG ends after there has been no treatment of the condition for an ETG specific number of days.

This interval is called the “clean period.”. For example, ETG 438300 (Acute Bronchitis) has a 30-day

clean period. This means that any claims related to that diagnosis that fall within a 30-day period will be

considered a recurrence of the same condition. When an episode is started for this ETG, all clinically

consistent claims activity for acute bronchitis group to this episode until the point where 30 days have

passed without any corresponding clinically consistent treatment. If a claim for this condition is

received after 30 days, a new episode is triggered. Only complete episodes are used in the evaluation

of OB/GYNs. Complete episodes are those that met the clean periods before and after the measure or

the episode was a chronic condition that lasted 365 days. There is a claims lag of three months used in

the episodes of care measurement. We use 2 years of complete episodes to evaluate OB/GYN

efficiency.

Episode severity is a term used to describe the severity of a member’s condition. ETG methodology

takes advantage of the relevant complication and comorbidity factors (indicating a sicker member who

may require more extensive treatment for a related condition) when determining an episode’s severity.

The result is a severity score and severity level for episodes. Typically, the higher the severity score,

the more that condition is expected to cost than for other members with a lower severity score for the

same condition.

Severity-adjusting episodes provides a powerful unit of analysis for comparing provider performance

when different providers care for members with the same condition and different severity levels.

As previously stated, high-cost claimants (HCC) have already been excluded. When comparing the

allowed cost to the expected cost of an episode, the expected value reflects the case-mix-adjusted

value for the OB/GYN members’ episodes. Outlier logic is applied at the case- mix category level. When

case-mix categories are created, episodes are flagged as outliers if that episode is outside of two

median absolute deviations away from the median allowed amounts for that case mix category. These

outliers are excluded from the analysis.

Proprietary

9

Case mix variables:

Variable within each ETG:

Hospital Referral

Region (HRR)

HRR Num level (Appendix A)

ETG code ETG code level (Appendix B)

Social

determinants of

health

Identifies variables that impact health care cost in a census tract area:

income, poverty, diversity, disability, education, physical inactivity,

marital status, public transportation. CDC and US census information

used to identify SDOH.

Specialty type OB/GYN

Age Age

Year of episode Two years: January 1, 2018–December 31, 2019

Severity level As indicated on the episode based on Symmetry. (Values are 0 to 4)

Business line Commercial

Pharmacy usage Whether or not the member has a pharmacy plan

HPD conditions All conditions (Appendix C)

Concurrent

episodes

Episodes that overlap each other by ETG code

Timing of

OBGYN entry

into episode

% of allowed amount that occurred in the episode before OB/GYN first

claim in episode

ICD 10 codes Frequency by which ICD10 appears in that episode

ERG risk score Optum Symmetry® Episode Risk Groups® (ERG®). Risk-adjusted

episodes of care created by the ETG grouper. This allows for a seamless

drill down from an ERG score into the episodes that are contributing to a

patient's risk.

Episode days

count

The length from the start of the episode to the end of the episode

Proprietary

10

Eligible population:

Administrative specification

Denominator Two denominators are created for each episode type/population

combination.

Commercial

Obstetric Adult Gynecology Adult

Denominator is the sum of the expected allowed amounts for the

episodes being attributed to the group. The expected allowed amount

is the case mix adjusted average for each ETG and its combination of

variables as described above.

Episode types

Obstetric adult score: These are ETG conditions are the pregnancy and

delivery episodes

Gynecology adult score: These are ETG conditions typically managed

by a general gynecology physician

Business lines Commercial

Ages OB/GYN: Adult population: 18 years and older

Continuous Complete and full year episodes are included, which means the episode

enrollment began and came to an end according to the rules of clean periods or were 12-

month episodes. Episodes longer than 12 months for chronic conditions are

not created by our warehouse to enable comparisons. For example, if a

chronic episode for one person is only 12 months long, it would not be

comparable to an episode for another person with the same condition that is

3 years long.

Measurement Two full years of episodes where the episode ends within the two-year time

time frame frame.

Benefit Medical (pharmacy if available)

Provider OB/GYN specialty specialty

category

Episode volume >5 non outlier pregnancy episodes OR >10 non outlier gynecology episodes

Total allowed $ Episodes must be greater than $0

Numerator Two numerators are created for each episode type/population

combination

Commercial

Obstetric adult

Gynecology adult

Numerator is the sum of the actual allowed amounts for the same

episodes in the denominator being attributed to the group

Proprietary

11

Episode efficiency evaluation and scoring

Step 1: Aggregate episode level data for OB/GYN practices.

a) Using episode data, identify all episodes for the measurement period. This data is evaluated at the

individual episode level for each tax ID attributed to the episode.

Step 2: Determine benchmark.

a) Benchmark allowed per episode is calculated using a decision tree machine learning model. Model

features include Optum Symmetry® Episode Risk Groups® (ERG®) retrospective risk score,

concurrent episodes, member comorbidities and Social Determinants of Health. Model R-

Squared is 0.73-0.81 excluding outliers.

Step 3: Determine OB/GYN performance evaluation result.

a) Calculate the episode-level performance index as total actual allowed amount/total benchmark

allowed amount.

b) Calculate the market adjusted episode level performance index as the episode level performance

index/market level performance index for the market the practice being measured is a part of.

The market and risk-level performance index are calculated as total actual episode allowed/total

benchmark episode allowed with the following combinations of variables for different OB/GYN

sub-populations:

• Commercial adult - Gynecology: Hospital referral region (HRR) and practice risk tier (low if

practice average risk score is ≤median, high otherwise)

• Commercial adult - Obstetric: HRR and practice-risk tier, Small TIN (small if episode count

is ≤median of episode count)

c) Calculate the overall weighted performance index for a practice by taking a weighted average of

the market-adjusted episode level performance index scores for that practice weighted by the

total benchmark allowed amount.

d) Conduct a two-sample weighted t-test comparing the practice’s market-adjusted performance

index weighted by the total benchmark allowed amount with the average market-adjusted

performance index from the relevant decision tree node weighted by the total benchmark allowed

amount. The t-test indicates whether there is a statistically significant difference between the

actual and expected episode-level performance indices.

• If the test has a p-value greater than 0.10, the practice results are not statistically

significant, and the practice outcome will be “Insufficient information."

• If the practice market-adjusted performance index is statistically significantly less than

the average market-adjusted performance index, the practice will receive a designation

of “Designation earned.”

• If the practice market-adjusted performance index is statistically significantly greater

than the average market-adjusted performance index, the practice outcome will be

“Criteria not met.”

Note: The weights used in the test are transformed with a degree of freedom correction. Using raw

expected amount values for weights makes the tails of the t-test distribution very thin, leading to most

test results having statistical significance. The correction standardizes the weights by their mean so

that the sum of the weights equals the number of observations and creates a higher bar for statistical

significance.

Proprietary

12

3. Clinical quality

Quality for OB/GYN providers is evaluated by HEDIS measures and the SMFM low risk c-section

measure.

The HEDIS® measures and the Society for Maternal Fetal Medicine’s (SMFM) low risk c-section rate

are used to evaluate the quality of care provided to members for preventative care management and

outcomes of care. HEDIS® measures are coded using the HEDIS® specifications to align with use of

industry accepted standards of measurement.

The measures chosen are those that cover a range of age groups and member conditions where

OB/GYN practices would manage those members and conditions.

Due to HEDIS copyright limitations, we can’t reproduce the exact HEDIS measure technical

specifications and value set content. Annual HEDIS technical specifications and value set content

area available here: http://store.ncqa.org/index.php/

List of HEDIS/SMFM measures used in quality analysis:

NCQA ID Measures

BCS Breast Cancer Screening

The percentage of women ages 50 years to 74 years who had a mammogram

to screen for breast cancer.

Note: A higher rate indicates better performance.

CCS Cervical Cancer Screening

The percentage of women ages 21 years to 64 years who were screened for cervical

cancer using either of the following criteria:

• Women ages 21 years to 64 years who had cervical cytology performed every

3 years.

• Women ages 30years to 64 years who had cervical cytology/human papillomavirus

(HPV) co-testing performed every 5 years.


COL Colorectal Cancer Screening

The percentage of members aged 50 years to 75 years who had appropriate

screening for colorectal cancer.


CHL Chlamydia Screening in Women

The percentage of women 16–24 years of age who were identified as sexually active and

who had at least one test for chlamydia during the measurement year.


PPC Timeliness of Prenatal Care

The percentage of deliveries of live births on or between October 8 of the year prior to

the measurement year and October 7 of the measurement year. The percentage of

deliveries that received a prenatal care visit in the first trimester, on or before the

enrollment start date or within 42 days of enrollment in the organization.


PPC Timeliness of Prenatal Care

http://store.ncqa.org/index.php/

Proprietary

13

The percentage of deliveries of live births on or between October 8 of the year prior to

the measurement year and October 7 of the measurement year. The percentage of

deliveries that received a prenatal care visit in the

first trimester, on or before the enrollment start date or within 42 days of enrollment in

the organization.


PPC Postpartum Care

The percentage of deliveries of live births on or between October 8 of the year prior to the

measurement year and October 7 of the measurement year. The percentage of deliveries

that had a postpartum visit on or between 7 and 84 days after delivery.


Non HEDIS

measure.

This is an

SMFM

endorsed

measure.

Low Risk C- section rate

This measure assesses the number of women with a term, singleton livebirth in a vertex

position delivered by cesarean section without a medical indication of high- risk delivery.

Note: A lower rate indicates better performance. This measure is reverse scored when combined

with HEDIS measure rates to create overall performance rate

Proprietary

14

Clinical quality evaluation and scoring

Step 1: Aggregate numerator and denominator values for each quality measure.

The OB/GYN designation measures OB/GYN practices based on quality performance on valid

members attributed by OB/GYN episodes of care to the practice. Performance is measured based on

data for the HEDIS measurement period ending December 31, 2019 and for the Low risk C section

rate based on 2019 claims data. Members must also have specific continuous enrollment

requirements in the HEDIS measure specifications.

Step 2: Determine OB/GYN practice’s performance.

This calculation is done separately for each unique population/measure combination for a practice.

Only measures where a practice has at least greater than 2 valid members in the denominator for a

patient population (obstetric or gynecology) are considered valid measures and included in the

assessment.

a) For each measure, calculate the actual score for each OB/GYN practice as the measure

numerator divided by the measure denominator.

b) Apply a Bayesian transformation to the actual measure score to create the adjusted

measure score. The Bayesian transformation is applied to adjust for OB/GYN practice

volume and measure variance. (See empirical Bayesian transformation example for

additional details.)


Benchmark utilization is calculated for each measure as the average adjusted measure score of a

peer group, defined as a combination of: measure, population (Gynecology or Obstetrics), practice

size, practice risk tier and geography type with a minimum number of TINs in each combination of

variables.


OB/GYN performance evaluation is done at the domain (population: Obstetrics or Gynecology) level.

For a physician group to receive a domain score, they must have at least three quality measures in

that domain with >2 denominators in those measures for each measure/population.

a) Create a confidence interval around the adjusted measure score, to create an upper and

lower bound.

b) Calculate an upper and lower bound for the measure level performance index.

c) The final performance index is calculated as the midpoint between the performance index

– lower bound and performance index – upper bound.

d) Create a normalized performance index. This normalization is done to account for

differences in average value and standard deviation across measures. A normalized index

is calculated for each measure as (final performance index – peer group measure level

mean)/peer group measure level standard deviation.

e) Create an aggregated OB/GYN practice level performance index. The practice level

performance index is calculated as the average of normalized measure-level indices.

f) The OB/GYN practice-level performance index is compared to 0. A statistical test

(0.1 significance level) is run to identify OB/GYN practices who are different from 0 in a way

that is statistically significant to award designation.

A full calculation example can be found in Appendix F.

Proprietary

15

Specifications of HEDIS/SMFM quality measures:

Chlamydia Screening in Women

Measure acronym: CHL Measure category: Prevention and Screening

Description: The percentage of women 16–24 years of age who were identified as sexually active and who had

at least one test for chlamydia during the measurement year.

Administrative specification:

Denominator Sexually active women 16–24 years as of December 31 of the measurement year. Exclude pregnant women and women in hospice

Numerator At least one chlamydia test during the measurement year.

Product lines &

benefit

Commercial Medical during the measurement year.

Continuous

enrollment &

allowable gap

The measurement year of 12 months and the year prior to the measurement year.

No more than one gap in continuous enrollment of up to 45 days during each year of

continuous enrollment.

Risk adjustment: None

Managing provider attribution: OB/GYN

Data collection approach: Aetna claims data, measurement year plus 3 months runout

Population: Adults

Measure type: GYN

Proprietary

16

Breast Cancer Screening

Measure acronym: BCS Measure category: Effectiveness of Care/Prevention & Screening

Description: The percentage of women ages 50 years to 74 years who had a mammogram to screen for breast

cancer.


Denominator Female members aged 52 years to 74 years as of December 31 of the measurement

year.

Denominator

exclusions

Exclude members who meet any of the following criteria:

• Medicare members 66 years of age and older as of December 31 of the

measurement year who meet either of the following:

• Enrolled in an Institutional SNP (I-SNP) any time during the measurement year.

• Living long-term in an institution any time during the measurement year

• Members 66–80 years of age as of December 31 of the measurement year with

frailty and advanced illness. Members must meet both of the following frailty and

advanced illness criteria to be excluded:

- At least one claim/encounter for frailty

- Any of the following during the measurement year or the year prior to the

measurement year (count services that occur over both years): At least two

outpatient visits, observation visits, ED visits, nonacute inpatient encounters

or nonacute inpatient discharges (instructions below) on different dates of

service, with an advanced illness diagnosis

• Members 81 years of age and older as of December 31 of the measurement year

with frailty during the measurement year.

• Members in hospice or using hospice services

• A dispensed dementia medication

• Bilateral mastectomy any time during the member’s history through December 31

of the measurement year

Numerator Female members with one or more mammograms any time on or between

two years prior to the measurement year.

Product lines &

benefit

Commercial

Medical during the measurement year.

Continuous

enrollment &

allowable gap

October 1 two years prior to the measurement year through December 31 of the

measurement year.

No more than one gap in enrollment of up to 45 days for each full calendar year of

continuous enrollment (i.e., the measurement year and the year prior to the

measurement year).




Population: Adults

Measure type: GYN

Proprietary

17

7 BCervical Cancer Screening

Measure acronym: CCS Measure category: Effectiveness of

Care/Prevention & Screening

Description:

The percentage of women ages 21 years to 64 years who were screened for cervical cancer using either of the

following criteria: • Women ages 21 years to 64 years who had cervical cytology performed every 3 years.

• Women ages 30 years to 64 years who had cervical cytology/human papillomavirus (HPV) • co-testing performed every 5 years.


Denominator Female members aged 21 years to 64 years.

Denominator

exclusions


• Members in hospice

• Hysterectomy with no residual cervix, cervical agenesis or acquired absence of

cervix any time during the member’s history through December 31 of the

measurement year

Numerator Female members who were screened for cervical cancer using:

• Women ages 21 years to 64 years who had cervical cytology performed

every 3 years.

• Women ages 30 years to 64 years who had cervical cytology/human

papillomavirus (HPV) co-testing performed every 5 years.

Product lines &

benefit


Continuous

enrollment &

allowable gap

The measurement year of 12 months and 2 years prior to the measurement year.

No more than one gap in enrollment of up to 45 days during each year of continuous

enrollment.




Population: Adults

Measure type: GYN

Proprietary

18

Colorectal Cancer Screening

Measure acronym: COL Measure category: Effectiveness of Care/Prevention & Screening

Description: The percentage of members aged 50 years to 75 years who had appropriate screening for colorectal

cancer.


Denominator Members aged 51–75 years as of December 31 of the measurement year.

Denominator

exclusions


• Medicare members 66 years of age and older as of December 31 of the measurement year who meet

either of the following:

− Enrolled in an Institutional SNP (I-SNP) any time during the measurement year.

− Living long-term in an institution any time during the measurement year

• Members 66–80 years of age as of December 31 of the measurement year with frailty and advanced

illness. Members must meet both of the following frailty and advanced illness criteria to be excluded:

− At least one claim/encounter for frailty

− Any of the following during the measurement year or the year prior to the measurement year

(count services that occur over both years): At least two outpatient visits, observation visits, ED

visits, nonacute inpatient encounters or nonacute inpatient discharges (instructions below) on

different dates of service, with an advanced illness diagnosis

• Members 81 years of age and older as of December 31 of the measurement year with frailty during the

measurement year.

• Members in hospice or using hospice services

• A dispensed dementia medication

• Colorectal cancer diagnosis or total colectomy any time during the member’s history through

December 31 of the measurement year

Numerator Members with one or more screenings for colorectal cancer using:

• Fecal occult blood test with the required number of samples returned, regardless of FOBT type,

during the measurement year.

• Flexible sigmoidoscopy during the measurement year or the four years prior to the measurement

year.

• Colonoscopy during the measurement year or the nine years prior to the measurement year.

• CT colonography during the measurement year or the four years prior to the measurement year.

• FIT-DNA test during the measurement year or the two years prior to the measurement year.

Product lines

& benefit


Continuous

enrollment &

allowable

gap

The measurement year of 12 months and 1 year prior to the measurement year.

No more than one gap in continuous enrollment of up to 45 days during each year of continuous

enrollment.




Population: Adults

Measure type: GYN

Proprietary

19

Timeliness of Prenatal Care

Measure acronym: PPC Measure category: Access and Availability

Description:

The percentage of deliveries of live births on or between October 8 of the year prior to the measurement year

and October 7 of the measurement year. The percentage of deliveries that received a prenatal care visit in the

first trimester, on or before the enrollment start date or within 42 days of enrollment in the organization


Denominator Identify all women with a delivery on or between October 8 of the year prior to the

measurement year and October 7 of the measurement year. Exclude non-live births.

Numerator A prenatal visit in the first trimester, on or before the enrollment start date or within 42

days of enrollment, depending on the date of enrollment in the organization and gaps

in enrollment during the pregnancy. Do not count visits that occur on the date of

delivery.

Product lines &

benefit

Commercial Medical, Pharmacy during the measurement year.

Continuous

enrollment &

allowable gap

Enrollment was continuous 43 days prior to delivery through 60 days after delivery,

with no gaps.




Population: Adults

Measure type: Obstetrics

Proprietary

20

Postpartum Care

Measure acronym: PPC Measure category: Access and Availability

Description:

The percentage of deliveries of live births on or between October 8 of the year prior to the measurement year

and October 7 of the measurement year. The percentage of deliveries that had a postpartum visit on or

between 7 and 84 days after delivery.


Denominator Identify all women with a delivery on or between October 8 of the year prior to the

measurement year and October 7 of the measurement year.

Exclude non-live births

Numerator A postpartum visit on or between 7 and 84 days after delivery, as documented

through either administrative data.

Product lines &

benefit

Commercial

Continuous

enrollment &

allowable gap

Enrollment was continuous 43 days prior to delivery through 60 days after delivery, with no gaps




Population: Adults

Measure type: Obstetrics

Proprietary

21

Cesarean Section Rate in Singleton Low-Risk Deliveries

Measure acronym: None Measure category: SMFM measure

Description:

This measure calculates the percentage of members delivered that meet both of the following criteria:

• Do not have a high- risk medical indication requiring a Cesarean section

• Deliver a term, singleton live birth in a vertex position by Cesarean section


Denominator Members that deliver a term, singleton live birth in a vertex position,

without a medical indication of high risk (see Appendix I) by an Ob/Gyn

provider and assigned a delivery DRG: 765, 766, 767, 768, 774, 775, 783,

784, 785, 786, 787, 788, 796, 797, 798, 805, 806, 807

Numerator Members in the denominator that deliver by cesarean section DRG: 765,

766, 783, 784, 785, 786, 787, 788

Product lines &

benefit

Commercial

Medical during the measurement year.

Continuous enrollment

& allowable gap

Member must be active as of the hospitalization admission date through

the hospitalization discharge date within the 12-month assessment

period.




Population: Adults

Measure type: Obstetric

Proprietary

22

Appendix A: Empirical Bayesian approach

The empirical Bayesian approach is used to identify statistical significance of a provider groups

results for quality and risk-adjusted utilization measures, for each population. The following are the

steps used to calculate the statistical significance:

1. Calculate the observed rate for each HEDIS quality measure.

2. Adjust observed rates for quality using empirical Bayesian approach:

a. Calculate the weighted national average and weighted national average variance for

each quality measure

b. Calculate TIN-measure level variance per TIN for each quality measure assuming

Normal distribution on original counts (i.e.: number of denominators in the quality

measure)

c. Update observed metrics based on national average, national variance, and TIN-

measure variance (i.e.: small TIN >less confident of observed metrics>larger

variance>adjust more to national average)

d. Update TIN-measure level variance based on national variance and TIN-measure

variance

e. Calculate the TIN-measure level Bayesian predictive variance based on the TIN-

measure level variance, updated TIN-measure level variance and TIN size

3. Calculate an expected value for each measure after Bayesian adjustment as weighted national

average risk-adjusted value.

a. Only members attributed to TINs with at least 3 attributed members within target

age groups are used to set the benchmark.

4. Calculate measure level O/E score by dividing observed risk-adjusted performance by expected

risk-adjusted performance.

a. Calculate the variance for measure-level O/E based on the Bayesian predictive

variance.

5. Calculate the TIN-level adjusted O/E.

a. For quality measures, TIN-level O/E are calculated for each domain by averaging the

O/E of the measures in that domain. TIN-level overall O/E is calculated by averaging

the domain O/E.

b. Calculate the variance for TIN-level O/E based on the TIN-level variance assuming

independence between measures.

6. Construct TIN-level Bayesian credible interval for adjusted O/E.95% credible interval used for

efficiency; 90% credible interval used for quality.

a. Calculate lower bound and upper bound of the credible interval based on TIN-level

adjusted O/E score and TIN-level O/E variance.

7. Apply statistical test to identify providers who are better than the benchmark in a way that is

statistically significant.

a. If the lower bound for CI is lower than 1 for quality, then ISS.

b. If the upper bound for the CI is higher than 1 for quality, then ESS.

c. Else NSS.

Proprietary

23

Appendix B: Hospital referral regions (HRRs) HRR Nbr HRR City HRR State

10 Anchorage AK

1 Birmingham AL

2 Dothan AL

5 Huntsville AL

6 Mobile AL

7 Montgomery AL

9 Tuscaloosa AL

16 Fort Smith AR

18 Jonesboro AR

19 Little Rock AR

21 Springdale AR

22 Texarkana AR

11 Mesa AZ

12 Phoenix AZ

14 Sun City AZ

15 Tucson AZ

23 Orange County CA

25 Bakersfield CA

31 Chico CA

33 Contra Costa County CA

43 Fresno CA

56 Los Angeles CA

58 Modesto CA

62 Napa CA

65 Alameda County CA

69 Palm Springs/Rancho Mira CA

73 Redding CA

77 Sacramento CA

78 Salinas CA

79 San Bernardino CA

80 San Diego CA

81 San Francisco CA

82 San Jose CA

83 San Luis Obispo CA

85 San Mateo County CA

86 Santa Barbara CA

87 Santa Cruz CA

89 Santa Rosa CA

91 Stockton CA

96 Ventura CA

101 Boulder CO

102 Colorado Springs CO

103 Denver CO

Proprietary

24

104 Fort Collins CO

105 Grand Junction CO

106 Greeley CO

107 Pueblo CO

109 Bridgeport CT

110 Hartford CT

111 New Haven CT

113 Washington DC

112 Wilmington DE

115 Bradenton FL

116 Clearwater FL

118 Fort Lauderdale FL

119 Fort Myers FL

120 Gainesville FL

122 Hudson FL

123 Jacksonville FL

124 Lakeland FL

127 Miami FL

129 Ocala FL

130 Orlando FL

131 Ormond Beach FL

133 Panama City FL

134 Pensacola FL

137 Sarasota FL

139 St. Petersburg FL

140 Tallahassee FL

141 Tampa FL

142 Albany GA

144 Atlanta GA

145 Augusta GA

146 Columbus GA

147 Macon GA

148 Rome GA

149 Savannah GA

150 Honolulu HI

190 Cedar Rapids IA

191 Davenport IA

192 Des Moines IA

193 Dubuque IA

194 Iowa City IA

195 Mason City IA

196 Sioux City IA

197 Waterloo IA

151 Boise ID

152 Idaho Falls ID

Proprietary

25

154 Aurora IL

155 Blue Island IL

156 Chicago IL

158 Elgin IL

161 Evanston IL

163 Hinsdale IL

164 Joliet IL

166 Melrose Park IL

170 Peoria IL

171 Rockford IL

172 Springfield IL

173 Urbana IL

175 Bloomington IL

179 Evansville IN

180 Fort Wayne IN

181 Gary IN

183 Indianapolis IN

184 Lafayette IN

185 Muncie IN

186 Munster IN

187 South Bend IN

188 Terre Haute IN

200 Topeka KS

201 Wichita KS

203 Covington KY

204 Lexington KY

205 Louisville KY

207 Owensboro KY

208 Paducah KY

209 Alexandria LA

210 Baton Rouge LA

212 Houma LA

213 Lafayette LA

214 Lake Charles LA

216 Metairie LA

217 Monroe LA

218 New Orleans LA

219 Shreveport LA

220 Slidell LA

227 Boston MA

230 Springfield MA

231 Worcester MA

223 Baltimore MD

225 Salisbury MD

226 Takoma Park MD

Proprietary

26

221 Bangor ME

222 Portland ME

232 Ann Arbor MI

233 Dearborn MI

234 Detroit MI

235 Flint MI

236 Grand Rapids MI

238 Kalamazoo MI

239 Lansing MI

240 Marquette MI

242 Muskegon MI

243 Petoskey MI

244 Pontiac MI

245 Royal Oak MI

246 Saginaw MI

248 St. Joseph MI

249 Traverse City MI

250 Duluth MN

251 Minneapolis MN

253 Rochester MN

254 St. Cloud MN

256 St. Paul MN

263 Cape Girardeau MO

264 Columbia MO

267 Joplin MO

268 Kansas City MO

270 Springfield MO

273 St. Louis MO

257 Gulfport MS

258 Hattiesburg MS

259 Jackson MS

260 Meridian MS

261 Oxford MS

262 Tupelo MS

274 Billings MT

275 Great Falls MT

276 Missoula MT

309 Asheville NC

311 Charlotte NC

312 Durham NC

313 Greensboro NC

314 Greenville NC

315 Hickory NC

318 Raleigh NC

319 Wilmington NC

Proprietary

27

320 Winston-Salem NC

321 Bismarck ND

322 Fargo/Moorhead MN ND

323 Grand Forks ND

324 Minot ND

277 Lincoln NE

278 Omaha NE

281 Lebanon NH

282 Manchester NH

283 Camden NJ

284 Hackensack NJ

285 Morristown NJ

288 New Brunswick NJ

289 Newark NJ

291 Paterson NJ

292 Ridgewood NJ

293 Albuquerque NM

279 Las Vegas NV

280 Reno NV

295 Albany NY

296 Binghamton NY

297 Bronx NY

299 Buffalo NY

300 Elmira NY

301 East Long Island NY

303 Manhattan NY

304 Rochester NY

307 Syracuse NY

308 White Plains NY

325 Akron OH

326 Canton OH

327 Cincinnati OH

328 Cleveland OH

329 Columbus OH

330 Dayton OH

331 Elyria OH

332 Kettering OH

334 Toledo OH

335 Youngstown OH

336 Lawton OK

339 Oklahoma City OK

340 Tulsa OK

341 Bend OR

342 Eugene OR

343 Medford OR

Proprietary

28

344 Portland OR

345 Salem OR

346 Allentown PA

347 Altoona PA

350 Danville PA

351 Erie PA

352 Harrisburg PA

354 Johnstown PA

355 Lancaster PA

356 Philadelphia PA

357 Pittsburgh PA

358 Reading PA

359 Sayre PA

360 Scranton PA

362 Wilkes-Barre PA

363 York PA

364 Providence RI

365 Charleston SC

366 Columbia SC

367 Florence SC

368 Greenville SC

369 Spartanburg SC

370 Rapid City SD

371 Sioux Falls SD

373 Chattanooga TN

374 Jackson TN

375 Johnson City TN

376 Kingsport TN

377 Knoxville TN

379 Memphis TN

380 Nashville TN

382 Abilene TX

383 Amarillo TX

385 Austin TX

386 Beaumont TX

388 Bryan TX

390 Corpus Christi TX

391 Dallas TX

393 El Paso TX

394 Fort Worth TX

396 Harlingen TX

397 Houston TX

399 Longview TX

400 Lubbock TX

402 McAllen TX

Proprietary

29

406 Odessa TX

411 San Angelo TX

412 San Antonio TX

413 Temple TX

416 Tyler TX

417 Victoria TX

418 Waco TX

420 Wichita Falls TX

421 Ogden UT

422 Provo UT

423 Salt Lake City UT

426 Arlington VA

427 Charlottesville VA

428 Lynchburg VA

429 Newport News VA

430 Norfolk VA

431 Richmond VA

432 Roanoke VA

435 Winchester VA

424 Burlington VT

437 Everett WA

438 Olympia WA

439 Seattle WA

440 Spokane WA

441 Tacoma WA

442 Yakima WA

446 Appleton WI

447 Green Bay WI

448 La Crosse WI

449 Madison WI

450 Marshfield WI

451 Milwaukee WI

452 Neenah WI

456 Wausau WI

443 Charleston WV

444 Huntington WV

445 Morgantown WV

457 Casper WY

Proprietary

30

Appendix C: ETG code list with condition category

ETG Code ETG Description Subcategory

779400000 Routine exam Gynecology

779600000 Contraceptive mgt, wo surg Gynecology

634900000 Menstrual condition, wo c,wo s Gynecology

634000000 Infection vagina exc monilial Gynecology

634700100 Non Mal F gen,w c,wo cm,wo s Gynecology

634900100 Menstrual condition, w c, wo s Gynecology

633900000 Monilial infection of vagina Gynecology

634700110 Non Mal F gen,w c,w cm,wo s Gynecology

634700101 Non Mal F gen,w c,wo cm,w s Gynecology

634200000 Endometriosis, wo surg Gynecology

634700000 Non Mal F gen,wo c,wo cm,wo s Gynecology

587200000 Sex transmitted dis, primary Gynecology

634200001 Endometriosis, w surg Gynecology

634700111 Non Mal F gen,w c,w cm,w s Gynecology

635100000 Infertility conditions,wo surg Gynecology

602200000 Spontaneous abortion Gynecology

779600001 Contraceptive mgt, w surg Gynecology

634700010 Non Mal F gen,wo c,w cm,wo s Gynecology

634900101 Menstrual condition, w c, w s Gynecology

634700001 Non Mal F gen,wo c,wo cm,w s Gynecology

602300000 Induced abortion Gynecology

634900001 Menstrual condition, wo c, w s Gynecology

602100001 Ectopic pregnancy, w surg Gynecology

634700011 Non Mal F gen,wo c,w cm,w s Gynecology

602100000 Ectopic pregnancy, wo surg Gynecology

635100001 Infertility conditions, w surg Gynecology

601100100 Preg w del,w c,wo cm, w/o cs Pregnancy

601100101 Preg w del,w c,wo cm,w cs Pregnancy

601100000 Preg w del,wo c,wo cm, w/o cs Pregnancy

601100110 Preg w del,w c,w cm, w/o cs Pregnancy

601100111 Preg w del,w c,w cm,w cs Pregnancy

601100001 Preg w del,wo c,wo cm,w cs Pregnancy

601100010 Preg w del,wo c,w cm, w/o cs Pregnancy

601100011 Preg w del,wo c,w cm,w cs Pregnancy

Proprietary

31

Appendix D: Health profile database (HPD) conditions

Health Profile Monitor Disease Code List

ADHD and other Childhood Disruptive Disorders

Alcoholism

Allergy

Anxiety

Asthma

Atrial Fibrillation

Attention Deficit Disorder

Autism

Benign Prostatic Hypertrophy

Bipolar

Bladder Cancer

Brain Cancer

Breast Cancer

Cataract

Cerebrovascular Disease

Cervical Cancer

Cholelithiasis/Cholecystitis

Chronic Fatigue Syndrome

Chronic Obstructive Pulmonary Disease

Chronic Renal Failure

Chronic Thyroid Disorders

Colorectal Cancer

Congenital Heart Disease

Cystic Fibrosis

Dementia

Depression

Diabetes Mellitus

Diverticular Disease

Down's Syndrome

Eating Disorders

Endometrial Cancer

Endometriosis

Epilepsy

Esophageal Cancer

Female Infertility

Fibromyalgia

Glaucoma

Head/Neck Cancer

Heart Failure

Hemophilia/Congenital Coagulopathies

Hepatitis

HIV/AIDS

Proprietary

32

Hodgkin's Disease/Lymphoma

Hypercoagulable Syndrome

Hyperlipidemia

Hypertension

Inflammatory Bowel Disease

Iron Deficiency Anemia

Ischemic Heart Disease

Kidney Stones

Leukemia/Myeloma

Low Back Pain

Low Vision and Blindness

Lung Cancer

Lyme Disease

Malignant Melanoma

Maternal Hist of Low Birth Weight or Preterm Birth

Menopause

Metabolic Syndrome

Migraine and Other Headaches

Multiple Sclerosis

Neurosis

Nonspecific Gastritis/Dyspepsia

Obesity

Oral Cancer

Osteoarthritis

Osteoporosis

Other Cancer

Otitis Media

Ovarian Cancer

Pancreatic Cancer

Pancreatitis

Parkinson's Disease

Peptic Ulcer Disease

Periodontal Disease

Peripheral Artery Disease

Post Partum BH Disorder

Prostate Cancer

Psychiatric Disorders related to Med Conditions

Psychoses

Rheumatoid Arthritis

Sickle Cell Anemia

Skin Cancer

Stomach Cancer

Substances Related Disorders

Systemic Lupus Erythematosus

Ventricular Arrhythmia

Proprietary

33

Appendix E: OB/GYN effectiveness (episode) performance evaluation example

This provides an example of the evaluation of practice performance for the episode- based

effectiveness metric.

Below is a fictional example for ABC Medical Group to illustrate how the calculation works. This

example will walk through the scoring process for ABC Medical Group’s adult population with

gynecology conditions.

Table 1 – ABC Medical Group Commercial Adult episode data

A B C D E

Row

number

ETG code HRR

market

Total actual

allowed amount

Total benchmark

allowed amount

Episode-level

performance index

Market-adjusted

episode-level performance index

1 164800000 119 $360 $383 0.94 0.94

2 164800000 119 $82 $153 0.54 0.54

3 164800000 119 $82 $165 0.50 0.50

4 164800000 119 $227 $165 1.37 1.37

5 164800000 119 $223 $230 0.97 0.97

6 164800000 119 $82 $230 0.36 0.36

7 164800000 119 $332 $327 1.02 1.01

8 164800000 119 $239 $327 0.73 0.73

9 164800000 119 $292 $327 0.89 0.89

10 164800000 119 $101 $327 0.31 0.31

11 164800000 119 $221 $327 0.68 0.68

12 164800000 119 $468 $333 1.40 1.40

13 164800100 119 $297 $313 0.95 0.94

14 164800100 119 $309 $435 0.71 0.71

15 164800100 119 $122 $435 0.28 0.28

16 164800100 119 $302 $390 0.78 0.77

17 164800100 119 $250 $390 0.64 0.64

18 164800100 119 $277 $390 0.71 0.71

19 164800100 119 $528 $390 1.35 1.35

20 164800100 119 $366 $390 0.94 0.93

21 164800100 119 $893 $603 1.48 1.48

22 164800100 119 $942 $470 2.00 2.00

23 164800100 119 $414 $529 0.78 0.78

24 164800100 119 $108 $803 0.13 0.13

25 164800100 119 $594 $348 1.70 1.70

26 239800100 119 $178 $209 0.85 0.85

27 387400110 119 $1,465 $854 1.72 1.71

28 388100010 119 $261 $266 0.98 0.98

29 388100010 119 $158 $290 0.54 0.54

30 388100010 119 $336 $512 0.66 0.65

31 388100010 119 $312 $283 1.10 1.10

Proprietary

34

Table 2 – Market reference data

HRR market Market

level performance

index

119 1.24

Step 1: Aggregate episode level data for OB/GYN practices.

a) Using episode data, identify all episodes for the measurement period. This data is evaluated at the

individual episode level for each tax ID attributed to the episode. For ABC Medical Group, this data is

represented in Table 1. Each row signifies a distinct episode attributed to the practice. In this

example, there were a total of 31 unique episodes adding up to $10,820 in total actual allowed

(Column B).


a) Benchmark allowed per episode is calculated using a decision tree machine

learning model. Model features include Optum Symmetry® Episode Risk

Groups®

(ERG®) retrospective risk score, concurrent episodes, member comorbidities and Social

Determinants of Health. Model R-Squared is 0.73-0.81 excluding outliers. In this example the

benchmark used for ABC Medical Group can be found in Column C in Table 1.


Calculate the episode-level performance index as total actual allowed amount/total benchmark

allowed amount. For ABC Medical Group, this is represented as B/C and the result is found in

Column D. For example, the episode-level performance index for Episode 1 is ($360/$383) =

9399 (~.94).

a) Calculate the market adjusted episode level performance index as the

episode level performance index/market level performance index for the

market the practice being measured is a part of. The market and risk-level

performance index are calculated as total actual episode allowed/total

benchmark episode allowed with the following combinations of variables for

different OB/GYN sub-populations:

a. Commercial adult - Gynecology: Hospital referral region (HRR) and

practice risk tier (low if practice average risk score is ≤median, high

otherwise)

b. Commercial adult – Obstetrics, Small TIN (small if episode count is ≤median of episode count), : HRR and practice-risk tier

ABC Medical Group is in HRR 119. The market level performance index for HRR 119 is 1.0024 in

Table 2. The market adjusted episode level performance index is calculated a D/1.0024 and the

results are found in Column E of Table 1. In this example, the market adjust episode level

performance index for Episode 1 is .94/1.0024 = .937 (~.94).

Calculate the overall weighted performance index for a practice by taking a weighted average of the

market adjusted episode level performance index scores for that practice weighted by the total

benchmark allowed amount. For ABC Medical Group this would be the sum product of Column C

and Column E in Table 1. ABC Medical Group’s overall performance index is 0.94.

b) Conduct a two-sample weighted t-test comparing the practice’s market-

Proprietary

35

adjusted performance index weighted by the total benchmark allowed

amount with the average market-adjusted performance index from the

relevant decision tree node weighted by the total benchmark allowed

amount. The t-test indicates whether there is a statistically significant

difference between the actual and expected episode-level performance

indices.

a. If the test has a p-value greater than 0.10, the practice results are

not statistically significant, and the practice outcome will be

“Insufficient information."

b. If the practice market-adjusted performance index is statistically

significantly less than the average market-adjusted performance

index, the practice will receive a designation of “Designation earned.”

c. If the practice market-adjusted performance index is statistically

significantly greater than the average market-adjusted performance

index, the practice outcome will be “Criteria not met.”

Note: The weights used in the test are transformed with a degree of freedom correction.

Using raw expected amount values for weights makes the tails of the t-test distribution

very thin, leading to most test results having statistical significance. The correction

standardizes the weights by their mean so that the sum of the weights equals the

number of observations and creates a higher bar for statistical significance.

Using this methodology and if the average of the relevant market- adjusted performance index

values are 1, the p-value of ABC Medical Group is 0.44. Thus, the practice is designated as NSS.

Appendix F: Clinical quality performance evaluation example

Proprietary

36

This provides an example of the evaluation of practice performance for clinical quality.

Below is a fictional example for ABC Medical Group to illustrate how the

calculation works. This example will walk through the scoring process for ABC

Medical Group’s commercial adult population.

Table 1 – Populations and categories for ABC Medical Group

Line of business Age group Group size Group risk tier Group geography

Commercial Adult Large High Risk Rural

Table 2 – ABC Medical Group Commercial Adult metric values A B C D E F G H I J

Measure

Type

Measure

Name

Num

erato

r

Denomi

nat or

Actual

measure

score

Adjusted

measure

score

Adjusted

measure

score –

lower bound

Adjusted

measure

score –

upper bound

Performanc

e index –

lower

bound

Performanc

e index –

upper

bound

Final

performanc

e index

Normalized

performanc

e index

Gynecology Breast

Cancer Screening

7 7 100% 96% 89% 97% .97 1.06 1.02 0.21

Gynecology Cervical

Cancer Screening

17 18 94% 95% 91% 95% .95 0.99 0.97 0.21

Gynecology Colorectal

Cancer Screening

7 8 88% 78% 68% 83% 1.09 1.33 1.21 0.21

Gynecology Chlamydia

Screening in

Women

6 13 46% 49% 40% 58% 0.59 0.85 0.72 0.21

Obstetrics Postpartum Care 2 9 22% 27% 17% 42% .30 0.74 0.53 -0.61

Obstetrics Timeliness of Prenatal Care

1 9 11% 17% 9% 33% 0.18 0.66 0.42 -0.61

Obstetrics Low risk C-section Rate

6 6 100% 95% 82% 98% 0.98 1.17 1.07 -0.61

Table 3 – ABC Medical Group relevant population values & benchmarks A B C

Measure Name Benchmark Peer group measure level final performance index mean

Peer group measure level

final performance index standard deviation

Breast Cancer

Screening

91% .96 .07

Cervical Cancer Screening

95% .98 .05

Colorectal Cancer

Screening

63% .98 .19

Chlamydia

Screening in

Women

68% .96 .24

Postpartum

Care

58% .98 .34

Timeliness of Prenatal Care

51% .99 .38

Proprietary

37

Low risk C-section Rate

84% .94 .13

Step 1: Aggregate numerator and denominator values for each quality measure.

The OB/GYN designation measures OB/GYN practices based on quality performance on valid

members attributed to the practice. Performance is measured based on data for the HEDIS

measurement period ending December 31, 2019. For ABC Medical Group, this is represented in

Columns A and B in Table 2.

Step 2: Determine OB/GYN practice’s performance.

This calculation is done separately for each unique population/measure combination

for a practice. Only measures where a practice has at least three valid members in the

denominator for a patient population are considered valid measures and included in the

assessment.

For each measure, calculate the actual score for each OB/GYN practice as the measure numerator

divided by the measure denominator. For ABC Medical Group, Column C in Table 2 represents that

actual measure level performance (C = A/B). For example, the actual score for ABC Medical

Group’s performance on Breast Cancer Screening is 7/7=100%.

Apply a Bayesian transformation to the actual measure score to create the adjusted measure score.

The Bayesian transformation is applied to adjust for OB/GYN practice volume and measure variance.

(See empirical Bayesian transformation example for additional details.) For ABC Medical Group, this

is represented in Column D. Continuing the Breast Cancer Screening example from part a, the

Adjusted measure score is 96%.


Benchmark utilization is calculated for each measure as the average adjusted measure score of a

peer group, defined as a combination of: measure, population (Obstetric or Gynecology), practice

size, practice risk tier and geography type with a minimum number of TINs in each combination of

variables. In this example, the benchmark used for ABC Medical Group can be found in Column A

in Table 3. The benchmark used for this population was the average utilization tied to groups in

the Commercial | Adult | Small Practice Size |High Risk Tier | Urban category.


OB/GYN performance evaluation is done at the domain level. For a physician group to

receive a domain score, they must have at least three quality measures in that domain

with at least three denominators in those measures for each measure/ population.

Create a confidence interval around the adjusted measure score, to create an upper and lower

bound. For ABC Medical Group, Column E in Table 2 represents the Adjusted measure score –

lower bound and Column F in Table 2 represents the Adjusted measure score – upper bound.

Following on the Breast Cancer Screening from above, the lower bound for the Breast Cancer

Screening rate for ABC Medical Group is 89% and the upper bound is 97%.

Calculate an upper and lower bound for the measure level performance index. For ABC Medical

Group, the upper bound of the performance index is found in Column H and is calculated as

Adjusted measure score – upper bound divided by the benchmark. Continuing our Breast Cancer

Proprietary

38

Screening example, the upper bound for Breast Cancer Screening is 97%/91%=1.06. The lower

bound of the performance index is found in Column G and is calculated as the adjusted measure

score – lower bound divided by the benchmark. Continuing our Breast Cancer Screening

example, the upper bound for Breast Cancer Screening is 89%/91%=0.97.

a) The final performance index is calculated as the midpoint between the performance index

– lower bound and performance index – upper bound. For ABC Medical Group, the final

performance index is found in Column I, and is calculated as the Adjusted measure score – lower

bound plus adjusted measure score – upper bound divided by 2.

Continuing our Breast Cancer Screening example, the final performance index is (1.06+0.97)/2 =

1.02.

Create a normalized performance index. This normalization is done to account for differences in

average value and standard deviation across measures. A normalized index is calculated for each

measure as (Final performance index – peer group measure level mean)/ peer group measure level

standard deviation. For ABC Medical Group, the normalized performance index is found in

Column J. Following on the Breast Cancer Screening example, the normalized performance

index is (1.02-.96)/.07=0.86.

Create an aggregated OB/GYN practice level performance index. The practice level performance

index is calculated as the average of normalized measure-level indices.

For ABC Medical Group, the practice level performance index for GYN is

(.86−. 20+1. 𝟐1-1.0)

=. 21

4 For ABC Medical Group, the practice level performance index for OB is

(-1.32−1.50+ 𝟏.0)

= - 0. 61 3

b) The OB/GYN practice-level performance index is compared to 0. A

statistical test (0.1 significance level) is run to identify OB/GYN practices who

are different from 0 in a way that is statistically significant to award

designation. For ABC Medical Group, the practice level score for GYN of .21

was compared to 0 and resulted in an outcome of “Designation earned” for

the designation.

Appendix G: High Risk Pregnancy Diagnosis

Proprietary

39

High Risk pregnancy diagnosis

Code ICD Description

B20 ICD10 HUMAN IMMUNODEFICIENCY VIRUS [HIV] DISEASE

O10.22 ICD10 PRE-EXISTING HYPERTENSIVE CHRONIC KIDNEY DISEASE COMPLICATING CHILDBIRTH

O10.32 ICD10 PRE-EXISTING HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE COMPLICATING CHILDBIRTH

O14.20 ICD10 HELLP SYNDROME (HELLP), UNSPECIFIED TRIMESTER

O14.22 ICD10 HELLP SYNDROME (HELLP), SECOND TRIMESTER

O14.23 ICD10 HELLP SYNDROME (HELLP), THIRD TRIMESTER

O14.24 ICD10 HELLP syndrome, complicating childbirth

O15.00 ICD10 ECLAMPSIA IN PREGNANCY, UNSPECIFIED TRIMESTER

O15.02 ICD10 ECLAMPSIA IN PREGNANCY, SECOND TRIMESTER

O15.03 ICD10 ECLAMPSIA IN PREGNANCY, THIRD TRIMESTER

O15.1 ICD10 ECLAMPSIA IN LABOR

O15.2 ICD10 ECLAMPSIA IN THE PUERPERIUM

O15.9 ICD10 ECLAMPSIA, UNSPECIFIED AS TO TIME PERIOD

O22.50 ICD10 CEREBRAL VENOUS THROMBOSIS IN PREGNANCY, UNSPECIFIED TRIMESTER

O22.51 ICD10 CEREBRAL VENOUS THROMBOSIS IN PREGNANCY, FIRST TRIMESTER

O22.52 ICD10 CEREBRAL VENOUS THROMBOSIS IN PREGNANCY, SECOND TRIMESTER

O22.53 ICD10 CEREBRAL VENOUS THROMBOSIS IN PREGNANCY, THIRD TRIMESTER

O30.001 ICD10 TWIN PREGNANCY, UNSPECIFIED NUMBER OF PLACENTA AND UNSPECIFIED NUMBER OF AMNIOTIC SACS, FIRST TRIMESTER

O30.002 ICD10 TWIN PREGNANCY, UNSPECIFIED NUMBER OF PLACENTA AND UNSPECIFIED NUMBER OF AMNIOTIC SACS, SECOND TRIMESTER

O30.003 ICD10 TWIN PREGNANCY, UNSPECIFIED NUMBER OF PLACENTA AND UNSPECIFIED NUMBER OF AMNIOTIC SACS, THIRD TRIMESTER

O30.009 ICD10 TWIN PREGNANCY, UNSPECIFIED NUMBER OF PLACENTA AND UNSPECIFIED NUMBER OF AMNIOTIC SACS, UNSPECIFIED TRIMESTER

O30.011 ICD10 TWIN PREGNANCY, MONOCHORIONIC/MONOAMNIOTIC, FIRST TRIMESTER

O30.012 ICD10 TWIN PREGNANCY, MONOCHORIONIC/MONOAMNIOTIC, SECOND TRIMESTER

O30.013 ICD10 TWIN PREGNANCY, MONOCHORIONIC/MONOAMNIOTIC, THIRD TRIMESTER

O30.019 ICD10 TWIN PREGNANCY, MONOCHORIONIC/MONOAMNIOTIC, UNSPECIFIED TRIMESTER

O30.021 ICD10 CONJOINED TWIN PREGNANCY, FIRST TRIMESTER

O30.022 ICD10 CONJOINED TWIN PREGNANCY, SECOND TRIMESTER

O30.023 ICD10 CONJOINED TWIN PREGNANCY, THIRD TRIMESTER

O30.029 ICD10 CONJOINED TWIN PREGNANCY, UNSPECIFIED TRIMESTER

O30.031 ICD10 TWIN PREGNANCY, MONOCHORIONIC/DIAMNIOTIC, FIRST TRIMESTER

O30.032 ICD10 TWIN PREGNANCY, MONOCHORIONIC/DIAMNIOTIC, SECOND TRIMESTER

O30.033 ICD10 TWIN PREGNANCY, MONOCHORIONIC/DIAMNIOTIC, THIRD TRIMESTER

O30.039 ICD10 TWIN PREGNANCY, MONOCHORIONIC/DIAMNIOTIC, UNSPECIFIED TRIMESTER

O30.041 ICD10 TWIN PREGNANCY, DICHORIONIC/DIAMNIOTIC, FIRST TRIMESTER

O30.042 ICD10 TWIN PREGNANCY, DICHORIONIC/DIAMNIOTIC, SECOND TRIMESTER

O30.043 ICD10 TWIN PREGNANCY, DICHORIONIC/DIAMNIOTIC, THIRD TRIMESTER

O30.049 ICD10 TWIN PREGNANCY, DICHORIONIC/DIAMNIOTIC, UNSPECIFIED TRIMESTER

O30.091 ICD10 TWIN PREGNANCY, UNABLE TO DETERMINE NUMBER OF PLACENTA AND NUMBER OF AMNIOTIC SACS, FIRST TRIMESTER

O30.092 ICD10 TWIN PREGNANCY, UNABLE TO DETERMINE NUMBER OF PLACENTA AND NUMBER OF AMNIOTIC SACS, SECOND TRIMESTER

O30.093 ICD10 TWIN PREGNANCY, UNABLE TO DETERMINE NUMBER OF PLACENTA AND NUMBER OF AMNIOTIC SACS, THIRD TRIMESTER

O30.099 ICD10 TWIN PREGNANCY, UNABLE TO DETERMINE NUMBER OF PLACENTA AND NUMBER OF AMNIOTIC SACS, UNSPECIFIED TRIMESTER

O30.101 ICD10 TRIPLET PREGNANCY, UNSPECIFIED NUMBER OF PLACENTA AND UNSPECIFIED NUMBER OF AMNIOTIC SACS, FIRST TRIMESTER

O30.102 ICD10 TRIPLET PREGNANCY, UNSPECIFIED NUMBER OF PLACENTA AND UNSPECIFIED NUMBER OF AMNIOTIC SACS, SECOND TRIMESTER

O30.103 ICD10 TRIPLET PREGNANCY, UNSPECIFIED NUMBER OF PLACENTA AND UNSPECIFIED NUMBER OF AMNIOTIC SACS, THIRD TRIMESTER

O30.109 ICD10 TRIPLET PREGNANCY, UNSPECIFIED NUMBER OF PLACENTA AND UNSPECIFIED NUMBER OF AMNIOTIC SACS, UNSPECIFIED TRIMESTER

O30.111 ICD10 TRIPLET PREGNANCY WITH TWO OR MORE MONOCHORIONIC FETUSES, FIRST TRIMESTER

O30.112 ICD10 TRIPLET PREGNANCY WITH TWO OR MORE MONOCHORIONIC FETUSES, SECOND TRIMESTER

O30.113 ICD10 TRIPLET PREGNANCY WITH TWO OR MORE MONOCHORIONIC FETUSES, THIRD TRIMESTER

O30.119 ICD10 TRIPLET PREGNANCY WITH TWO OR MORE MONOCHORIONIC FETUSES, UNSPECIFIED TRIMESTER

O30.121 ICD10 TRIPLET PREGNANCY WITH TWO OR MORE MONOAMNIOTIC FETUSES, FIRST TRIMESTER

Proprietary

40

O30.122 ICD10 TRIPLET PREGNANCY WITH TWO OR MORE MONOAMNIOTIC FETUSES, SECOND TRIMESTER

O30.123 ICD10 TRIPLET PREGNANCY WITH TWO OR MORE MONOAMNIOTIC FETUSES, THIRD TRIMESTER

O30.129 ICD10 TRIPLET PREGNANCY WITH TWO OR MORE MONOAMNIOTIC FETUSES, UNSPECIFIED TRIMESTER

O30.191 ICD10 TRIPLET PREGNANCY, UNABLE TO DETERMINE NUMBER OF PLACENTA AND NUMBER OF AMNIOTIC SACS, FIRST TRIMESTER

O30.192 ICD10 TRIPLET PREGNANCY, UNABLE TO DETERMINE NUMBER OF PLACENTA AND NUMBER OF AMNIOTIC SACS, SECOND TRIMESTER

O30.193 ICD10 TRIPLET PREGNANCY, UNABLE TO DETERMINE NUMBER OF PLACENTA AND NUMBER OF AMNIOTIC SACS, THIRD TRIMESTER

O30.199 ICD10 TRIPLET PREGNANCY, UNABLE TO DETERMINE NUMBER OF PLACENTA AND NUMBER OF AMNIOTIC SACS, UNSPECIFIED TRIMESTER

O30.201 ICD10 QUADRUPLET PREGNANCY, UNSPECIFIED NUMBER OF PLACENTA AND UNSPECIFIED NUMBER OF AMNIOTIC SACS, FIRST TRIMESTER

O30.202 ICD10 QUADRUPLET PREGNANCY, UNSPECIFIED NUMBER OF PLACENTA AND UNSPECIFIED NUMBER OF AMNIOTIC SACS, SECOND TRIMESTER

O30.203 ICD10 QUADRUPLET PREGNANCY, UNSPECIFIED NUMBER OF PLACENTA AND UNSPECIFIED NUMBER OF AMNIOTIC SACS, THIRD TRIMESTER

O30.209 ICD10 QUADRUPLET PREGNANCY, UNSPECIFIED NUMBER OF PLACENTA AND UNSPECIFIED NUMBER OF AMNIOTIC SACS, UNSPECIFIED TRIMESTER

O30.211 ICD10 QUADRUPLET PREGNANCY WITH TWO OR MORE MONOCHORIONIC FETUSES, FIRST TRIMESTER

O30.212 ICD10 QUADRUPLET PREGNANCY WITH TWO OR MORE MONOCHORIONIC FETUSES, SECOND TRIMESTER

O30.213 ICD10 QUADRUPLET PREGNANCY WITH TWO OR MORE MONOCHORIONIC FETUSES, THIRD TRIMESTER

O30.219 ICD10 QUADRUPLET PREGNANCY WITH TWO OR MORE MONOCHORIONIC FETUSES, UNSPECIFIED TRIMESTER

O30.221 ICD10 QUADRUPLET PREGNANCY WITH TWO OR MORE MONOAMNIOTIC FETUSES, FIRST TRIMESTER

O30.222 ICD10 QUADRUPLET PREGNANCY WITH TWO OR MORE MONOAMNIOTIC FETUSES, SECOND TRIMESTER

O30.223 ICD10 QUADRUPLET PREGNANCY WITH TWO OR MORE MONOAMNIOTIC FETUSES, THIRD TRIMESTER

O30.229 ICD10 QUADRUPLET PREGNANCY WITH TWO OR MORE MONOAMNIOTIC FETUSES, UNSPECIFIED TRIMESTER

O30.291 ICD10 QUADRUPLET PREGNANCY, UNABLE TO DETERMINE NUMBER OF PLACENTA AND NUMBER OF AMNIOTIC SACS, FIRST TRIMESTER

O30.292 ICD10 QUADRUPLET PREGNANCY, UNABLE TO DETERMINE NUMBER OF PLACENTA AND NUMBER OF AMNIOTIC SACS, SECOND TRIMESTER

O30.293 ICD10 QUADRUPLET PREGNANCY, UNABLE TO DETERMINE NUMBER OF PLACENTA AND NUMBER OF AMNIOTIC SACS, THIRD TRIMESTER

O30.299 ICD10 QUADRUPLET PREGNANCY, UNABLE TO DETERMINE NUMBER OF PLACENTA AND NUMBER OF AMNIOTIC SACS, UNSPECIFIED TRIMESTER

O30.801 ICD10 OTHER SPECIFIED MULTIPLE GESTATION, UNSPECIFIED NUMBER OF PLACENTA AND UNSPECIFIED NUMBER OF AMNIOTIC SACS, FIRST TRIMESTER

O30.802 ICD10 OTHER SPECIFIED MULTIPLE GESTATION, UNSPECIFIED NUMBER OF PLACENTA AND UNSPECIFIED NUMBER OF AMNIOTIC SACS, SECOND TRIMESTER

O30.803 ICD10 OTHER SPECIFIED MULTIPLE GESTATION, UNSPECIFIED NUMBER OF PLACENTA AND UNSPECIFIED NUMBER OF AMNIOTIC SACS, THIRD TRIMESTER

O30.809 ICD10 OTHER SPECIFIED MULTIPLE GESTATION, UNSPECIFIED NUMBER OF PLACENTA AND UNSPECIFIED NUMBER OF AMNIOTIC SACS, UNSPECIFIED TRIMESTER

O30.811 ICD10 OTHER SPECIFIED MULTIPLE GESTATION WITH TWO OR MORE MONOCHORIONIC FETUSES, FIRST TRIMESTER

O30.812 ICD10 OTHER SPECIFIED MULTIPLE GESTATION WITH TWO OR MORE MONOCHORIONIC FETUSES, SECOND TRIMESTER

O30.813 ICD10 OTHER SPECIFIED MULTIPLE GESTATION WITH TWO OR MORE MONOCHORIONIC FETUSES, THIRD TRIMESTER

O30.819 ICD10 OTHER SPECIFIED MULTIPLE GESTATION WITH TWO OR MORE MONOCHORIONIC FETUSES, UNSPECIFIED TRIMESTER

O30.821 ICD10 OTHER SPECIFIED MULTIPLE GESTATION WITH TWO OR MORE MONOAMNIOTIC FETUSES, FIRST TRIMESTER

O30.822 ICD10 OTHER SPECIFIED MULTIPLE GESTATION WITH TWO OR MORE MONOAMNIOTIC FETUSES, SECOND TRIMESTER

O30.823 ICD10 OTHER SPECIFIED MULTIPLE GESTATION WITH TWO OR MORE MONOAMNIOTIC FETUSES, THIRD TRIMESTER

O30.829 ICD10 OTHER SPECIFIED MULTIPLE GESTATION WITH TWO OR MORE MONOAMNIOTIC FETUSES, UNSPECIFIED TRIMESTER

O30.891 ICD10 OTHER SPECIFIED MULTIPLE GESTATION, UNABLE TO DETERMINE NUMBER OF PLACENTA AND NUMBER OF AMNIOTIC SACS, FIRST TRIMESTER

O30.892 ICD10 OTHER SPECIFIED MULTIPLE GESTATION, UNABLE TO DETERMINE NUMBER OF PLACENTA AND NUMBER OF AMNIOTIC SACS, SECOND TRIMESTER

O30.893 ICD10 OTHER SPECIFIED MULTIPLE GESTATION, UNABLE TO DETERMINE NUMBER OF PLACENTA AND NUMBER OF AMNIOTIC SACS, THIRD TRIMESTER

O30.899 ICD10 OTHER SPECIFIED MULTIPLE GESTATION, UNABLE TO DETERMINE NUMBER OF PLACENTA AND NUMBER OF AMNIOTIC SACS, UNSPECIFIED TRIMESTER

O30.90 ICD10 MULTIPLE GESTATION, UNSPECIFIED, UNSPECIFIED TRIMESTER

Proprietary

41

O30.91 ICD10 MULTIPLE GESTATION, UNSPECIFIED, FIRST TRIMESTER

O30.92 ICD10 MULTIPLE GESTATION, UNSPECIFIED, SECOND TRIMESTER

O30.93 ICD10 MULTIPLE GESTATION, UNSPECIFIED, THIRD TRIMESTER

O31.00X0 ICD10 PAPYRACEOUS FETUS, UNSPECIFIED TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O31.00X1 ICD10 PAPYRACEOUS FETUS, UNSPECIFIED TRIMESTER, FETUS 1





O31.00X9 ICD10 PAPYRACEOUS FETUS, UNSPECIFIED TRIMESTER, OTHER FETUS

O31.01X0 ICD10 PAPYRACEOUS FETUS, FIRST TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O31.01X1 ICD10 PAPYRACEOUS FETUS, FIRST TRIMESTER, FETUS 1





O31.01X9 ICD10 PAPYRACEOUS FETUS, FIRST TRIMESTER, OTHER FETUS

O31.02X0 ICD10 PAPYRACEOUS FETUS, SECOND TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O31.02X1 ICD10 PAPYRACEOUS FETUS, SECOND TRIMESTER, FETUS 1





O31.02X9 ICD10 PAPYRACEOUS FETUS, SECOND TRIMESTER, OTHER FETUS

O31.03X0 ICD10 PAPYRACEOUS FETUS, THIRD TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O31.03X1 ICD10 PAPYRACEOUS FETUS, THIRD TRIMESTER, FETUS 1





O31.03X9 ICD10 PAPYRACEOUS FETUS, THIRD TRIMESTER, OTHER FETUS

O31.10X0 ICD10

CONTINUING PREGNANCY AFTER SPONTANEOUS ABORTION OF ONE FETUS OR MORE, UNSPECIFIED TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O31.10X0 ICD10


O31.10X0 ICD10


O31.10X0 ICD10


O31.10X1 ICD10 CONTINUING PREGNANCY AFTER SPONTANEOUS ABORTION OF ONE FETUS OR MORE, UNSPECIFIED TRIMESTER, FETUS 1






O31.10X9 ICD10 CONTINUING PREGNANCY AFTER SPONTANEOUS ABORTION OF ONE FETUS OR MORE, UNSPECIFIED TRIMESTER, OTHER FETUS

O31.11X0 ICD10

CONTINUING PREGNANCY AFTER SPONTANEOUS ABORTION OF ONE FETUS OR MORE, FIRST TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O31.11X0 ICD10


O31.11X0 ICD10


O31.11X0 ICD10


Proprietary

42

O31.11X0 ICD10


O31.11X0 ICD10


O31.11X0 ICD10


O31.11X0 ICD10


O31.11X1 ICD10 CONTINUING PREGNANCY AFTER SPONTANEOUS ABORTION OF ONE FETUS OR MORE, FIRST TRIMESTER, FETUS 1








O31.11X9 ICD10 CONTINUING PREGNANCY AFTER SPONTANEOUS ABORTION OF ONE FETUS OR MORE, FIRST TRIMESTER, OTHER FETUS

O31.12X0 ICD10

CONTINUING PREGNANCY AFTER SPONTANEOUS ABORTION OF ONE FETUS OR MORE, SECOND TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O31.12X0 ICD10


O31.12X0 ICD10


O31.12X0 ICD10


O31.12X1 ICD10 CONTINUING PREGNANCY AFTER SPONTANEOUS ABORTION OF ONE FETUS OR MORE, SECOND TRIMESTER, FETUS 1








O31.12X9 ICD10 CONTINUING PREGNANCY AFTER SPONTANEOUS ABORTION OF ONE FETUS OR MORE, SECOND TRIMESTER, OTHER FETUS

O31.13X0 ICD10

CONTINUING PREGNANCY AFTER SPONTANEOUS ABORTION OF ONE FETUS OR MORE, THIRD TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O31.13X0 ICD10


O31.13X0 ICD10


O31.13X0 ICD10


O31.13X1 ICD10 CONTINUING PREGNANCY AFTER SPONTANEOUS ABORTION OF ONE FETUS OR MORE, THIRD TRIMESTER, FETUS 1








O31.13X9 ICD10 CONTINUING PREGNANCY AFTER SPONTANEOUS ABORTION OF ONE FETUS OR MORE, THIRD TRIMESTER, OTHER FETUS

O31.20X0 ICD10 CONTINUING PREGNANCY AFTER INTRAUTERINE DEATH OF ONE FETUS OR MORE, UNSPECIFIED TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O31.20X1 ICD10 CONTINUING PREGNANCY AFTER INTRAUTERINE DEATH OF ONE FETUS OR MORE, UNSPECIFIED TRIMESTER, FETUS 1




Proprietary

43


O31.20X9 ICD10 CONTINUING PREGNANCY AFTER INTRAUTERINE DEATH OF ONE FETUS OR MORE, UNSPECIFIED TRIMESTER, OTHER FETUS

O31.21X0 ICD10

CONTINUING PREGNANCY AFTER INTRAUTERINE DEATH OF ONE FETUS OR MORE, FIRST TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O31.21X0 ICD10


O31.21X0 ICD10


O31.21X0 ICD10


O31.21X1 ICD10 CONTINUING PREGNANCY AFTER INTRAUTERINE DEATH OF ONE FETUS OR MORE, FIRST TRIMESTER, FETUS 1








O31.21X9 ICD10 CONTINUING PREGNANCY AFTER INTRAUTERINE DEATH OF ONE FETUS OR MORE, FIRST TRIMESTER, OTHER FETUS

O31.22X0 ICD10 CONTINUING PREGNANCY AFTER INTRAUTERINE DEATH OF ONE FETUS OR MORE, SECOND TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O31.22X1 ICD10 CONTINUING PREGNANCY AFTER INTRAUTERINE DEATH OF ONE FETUS OR MORE, SECOND TRIMESTER, FETUS 1





O31.22X9 ICD10 CONTINUING PREGNANCY AFTER INTRAUTERINE DEATH OF ONE FETUS OR MORE, SECOND TRIMESTER, OTHER FETUS

O31.23X0 ICD10 CONTINUING PREGNANCY AFTER INTRAUTERINE DEATH OF ONE FETUS OR MORE, THIRD TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O31.23X1 ICD10 CONTINUING PREGNANCY AFTER INTRAUTERINE DEATH OF ONE FETUS OR MORE, THIRD TRIMESTER, FETUS 1





O31.23X9 ICD10 CONTINUING PREGNANCY AFTER INTRAUTERINE DEATH OF ONE FETUS OR MORE, THIRD TRIMESTER, OTHER FETUS

O31.30X0 ICD10

CONTINUING PREGNANCY AFTER ELECTIVE FETAL REDUCTION OF ONE FETUS OR MORE, UNSPECIFIED TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O31.30X1 ICD10 CONTINUING PREGNANCY AFTER ELECTIVE FETAL REDUCTION OF ONE FETUS OR MORE, UNSPECIFIED TRIMESTER, FETUS 1





O31.30X9 ICD10 CONTINUING PREGNANCY AFTER ELECTIVE FETAL REDUCTION OF ONE FETUS OR MORE, UNSPECIFIED TRIMESTER, OTHER FETUS

O31.31X0 ICD10

CONTINUING PREGNANCY AFTER ELECTIVE FETAL REDUCTION OF ONE FETUS OR MORE, FIRST TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O31.31X0 ICD10

CONTINUING PREGNANCY AFTER ELECTIVE FETAL REDUCTION OF ONE FETUS OR MORE, FIRST TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O31.31X1 ICD10 CONTINUING PREGNANCY AFTER ELECTIVE FETAL REDUCTION OF ONE FETUS OR MORE, FIRST TRIMESTER, FETUS 1






O31.31X9 ICD10 CONTINUING PREGNANCY AFTER ELECTIVE FETAL REDUCTION OF ONE FETUS OR MORE, FIRST TRIMESTER, OTHER FETUS

Proprietary

44

O31.32X0 ICD10

CONTINUING PREGNANCY AFTER ELECTIVE FETAL REDUCTION OF ONE FETUS OR MORE, SECOND TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O31.32X0 ICD10

CONTINUING PREGNANCY AFTER ELECTIVE FETAL REDUCTION OF ONE FETUS OR MORE, SECOND TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O31.32X1 ICD10 CONTINUING PREGNANCY AFTER ELECTIVE FETAL REDUCTION OF ONE FETUS OR MORE, SECOND TRIMESTER, FETUS 1






O31.32X9 ICD10 CONTINUING PREGNANCY AFTER ELECTIVE FETAL REDUCTION OF ONE FETUS OR MORE, SECOND TRIMESTER, OTHER FETUS

O31.33X0 ICD10

CONTINUING PREGNANCY AFTER ELECTIVE FETAL REDUCTION OF ONE FETUS OR MORE, THIRD TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O31.33X0 ICD10

CONTINUING PREGNANCY AFTER ELECTIVE FETAL REDUCTION OF ONE FETUS OR MORE, THIRD TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O31.33X1 ICD10 CONTINUING PREGNANCY AFTER ELECTIVE FETAL REDUCTION OF ONE FETUS OR MORE, THIRD TRIMESTER, FETUS 1






O31.33X9 ICD10 CONTINUING PREGNANCY AFTER ELECTIVE FETAL REDUCTION OF ONE FETUS OR MORE, THIRD TRIMESTER, OTHER FETUS

O31.8X10 ICD10 OTHER COMPLICATIONS SPECIFIC TO MULTIPLE GESTATION, FIRST TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O31.8X11 ICD10 OTHER COMPLICATIONS SPECIFIC TO MULTIPLE GESTATION, FIRST TRIMESTER, FETUS 1





O31.8X19 ICD10 OTHER COMPLICATIONS SPECIFIC TO MULTIPLE GESTATION, FIRST TRIMESTER, OTHER FETUS

O31.8X20 ICD10 OTHER COMPLICATIONS SPECIFIC TO MULTIPLE GESTATION, SECOND TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O31.8X21 ICD10 OTHER COMPLICATIONS SPECIFIC TO MULTIPLE GESTATION, SECOND TRIMESTER, FETUS 1





O31.8X29 ICD10 OTHER COMPLICATIONS SPECIFIC TO MULTIPLE GESTATION, SECOND TRIMESTER, OTHER FETUS

O31.8X30 ICD10 OTHER COMPLICATIONS SPECIFIC TO MULTIPLE GESTATION, THIRD TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O31.8X31 ICD10 OTHER COMPLICATIONS SPECIFIC TO MULTIPLE GESTATION, THIRD TRIMESTER, FETUS 1





O31.8X39 ICD10 OTHER COMPLICATIONS SPECIFIC TO MULTIPLE GESTATION, THIRD TRIMESTER, OTHER FETUS

O31.8X90 ICD10 OTHER COMPLICATIONS SPECIFIC TO MULTIPLE GESTATION, UNSPECIFIED TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O31.8X91 ICD10 OTHER COMPLICATIONS SPECIFIC TO MULTIPLE GESTATION, UNSPECIFIED TRIMESTER, FETUS 1





O31.8X99 ICD10 OTHER COMPLICATIONS SPECIFIC TO MULTIPLE GESTATION, UNSPECIFIED TRIMESTER, OTHER FETUS

O32.0XX1 ICD10 MATERNAL CARE FOR UNSTABLE LIE, FETUS 1



Proprietary

45



O32.0XX9 ICD10 MATERNAL CARE FOR UNSTABLE LIE, OTHER FETUS

O32.1XX0 ICD10 MATERNAL CARE FOR BREECH PRESENTATION, NOT APPLICABLE OR UNSPECIFIED

O32.1XX1 ICD10 MATERNAL CARE FOR BREECH PRESENTATION, FETUS 1





O32.1XX9 ICD10 MATERNAL CARE FOR BREECH PRESENTATION, OTHER FETUS

O32.2XX0 ICD10 MATERNAL CARE FOR TRANSVERSE AND OBLIQUE LIE, NOT APPLICABLE OR UNSPECIFIED

O32.2XX1 ICD10 MATERNAL CARE FOR TRANSVERSE AND OBLIQUE LIE, FETUS 1





O32.2XX9 ICD10 MATERNAL CARE FOR TRANSVERSE AND OBLIQUE LIE, OTHER FETUS

O32.3XX0 ICD10 MATERNAL CARE FOR FACE, BROW AND CHIN PRESENTATION, NOT APPLICABLE OR UNSPECIFIED

O32.3XX1 ICD10 MATERNAL CARE FOR FACE, BROW AND CHIN PRESENTATION, FETUS 1





O32.3XX9 ICD10 MATERNAL CARE FOR FACE, BROW AND CHIN PRESENTATION, OTHER FETUS

O32.4XX1 ICD10 MATERNAL CARE FOR HIGH HEAD AT TERM, FETUS 1





O32.4XX9 ICD10 MATERNAL CARE FOR HIGH HEAD AT TERM, OTHER FETUS

O32.6XX1 ICD10 MATERNAL CARE FOR COMPOUND PRESENTATION, FETUS 1





O32.6XX9 ICD10 MATERNAL CARE FOR COMPOUND PRESENTATION, OTHER FETUS

O32.8XX1 ICD10 MATERNAL CARE FOR OTHER MALPRESENTATION OF FETUS, FETUS 1





O32.8XX9 ICD10 MATERNAL CARE FOR OTHER MALPRESENTATION OF FETUS, OTHER FETUS

O32.9XX1 ICD10 MATERNAL CARE FOR MALPRESENTATION OF FETUS, UNSPECIFIED, FETUS 1





O32.9XX9 ICD10 MATERNAL CARE FOR MALPRESENTATION OF FETUS, UNSPECIFIED, OTHER FETUS

O33.3XX1 ICD10 MATERNAL CARE FOR DISPROPORTION DUE TO OUTLET CONTRACTION OF PELVIS, FETUS 1



Proprietary

46



O33.3XX9 ICD10 MATERNAL CARE FOR DISPROPORTION DUE TO OUTLET CONTRACTION OF PELVIS, OTHER FETUS

O33.4XX1 ICD10 MATERNAL CARE FOR DISPROPORTION OF MIXED MATERNAL AND FETAL ORIGIN, FETUS 1





O33.4XX9 ICD10 MATERNAL CARE FOR DISPROPORTION OF MIXED MATERNAL AND FETAL ORIGIN, OTHER FETUS

O33.5XX1 ICD10 MATERNAL CARE FOR DISPROPORTION DUE TO UNUSUALLY LARGE FETUS, FETUS 1





O33.5XX9 ICD10 MATERNAL CARE FOR DISPROPORTION DUE TO UNUSUALLY LARGE FETUS, OTHER FETUS

O33.6XX0 ICD10 MATERNAL CARE FOR DISPROPORTION DUE TO HYDROCEPHALIC FETUS, NOT APPLICABLE OR UNSPECIFIED

O33.6XX1 ICD10 MATERNAL CARE FOR DISPROPORTION DUE TO HYDROCEPHALIC FETUS, FETUS 1





O33.6XX9 ICD10 MATERNAL CARE FOR DISPROPORTION DUE TO HYDROCEPHALIC FETUS, OTHER FETUS

O33.7 ICD10 MATERNAL CARE FOR DISPROPORTION DUE TO OTHER FETAL DEFORMITIES

O33.7XX0 ICD10 Maternal care for disproportion due to other fetal deformities, not applicable or unspecified

O33.7XX1 ICD10 Maternal care for disproportion due to other fetal deformities, fetus 1





O33.7XX9 ICD10 Maternal care for disproportion due to other fetal deformities, other fetus

O34.21 ICD10 MATERNAL CARE FOR SCAR FROM PREVIOUS CESAREAN DELIVERY

O34.211 ICD10 Maternal care for low transverse scar from previous cesarean delivery

O34.212 ICD10 Maternal care for vertical scar from previous cesarean delivery

O34.219 ICD10 Maternal care for unspecified type scar from previous cesarean delivery

O34.513 ICD10 MATERNAL CARE FOR INCARCERATION OF GRAVID UTERUS, THIRD TRIMESTER

O35.0XX0 ICD10 MATERNAL CARE FOR (SUSPECTED) CENTRAL NERVOUS SYSTEM MALFORMATION IN FETUS, NOT APPLICABLE OR UNSPECIFIED

O35.0XX1 ICD10 MATERNAL CARE FOR (SUSPECTED) CENTRAL NERVOUS SYSTEM MALFORMATION IN FETUS, FETUS 1





O35.0XX9 ICD10 MATERNAL CARE FOR (SUSPECTED) CENTRAL NERVOUS SYSTEM MALFORMATION IN FETUS, OTHER FETUS

O35.1XX1 ICD10 MATERNAL CARE FOR (SUSPECTED) CHROMOSOMAL ABNORMALITY IN FETUS, FETUS 1





O35.1XX9 ICD10 MATERNAL CARE FOR (SUSPECTED) CHROMOSOMAL ABNORMALITY IN FETUS, OTHER FETUS

O35.2XX1 ICD10 MATERNAL CARE FOR (SUSPECTED) HEREDITARY DISEASE IN FETUS, FETUS 1



Proprietary

47



O35.2XX9 ICD10 MATERNAL CARE FOR (SUSPECTED) HEREDITARY DISEASE IN FETUS, OTHER FETUS

O35.3XX1 ICD10 MATERNAL CARE FOR (SUSPECTED) DAMAGE TO FETUS FROM VIRAL DISEASE IN MOTHER, FETUS 1





O35.3XX9 ICD10 MATERNAL CARE FOR (SUSPECTED) DAMAGE TO FETUS FROM VIRAL DISEASE IN MOTHER, OTHER FETUS

O35.4XX1 ICD10 MATERNAL CARE FOR (SUSPECTED) DAMAGE TO FETUS FROM ALCOHOL, FETUS 1





O35.4XX9 ICD10 MATERNAL CARE FOR (SUSPECTED) DAMAGE TO FETUS FROM ALCOHOL, OTHER FETUS

O35.5XX1 ICD10 MATERNAL CARE FOR (SUSPECTED) DAMAGE TO FETUS BY DRUGS, FETUS 1





O35.5XX9 ICD10 MATERNAL CARE FOR (SUSPECTED) DAMAGE TO FETUS BY DRUGS, OTHER FETUS

O35.6XX1 ICD10 MATERNAL CARE FOR (SUSPECTED) DAMAGE TO FETUS BY RADIATION, FETUS 1





O35.6XX9 ICD10 MATERNAL CARE FOR (SUSPECTED) DAMAGE TO FETUS BY RADIATION, OTHER FETUS

O35.7XX1 ICD10 MATERNAL CARE FOR (SUSPECTED) DAMAGE TO FETUS BY OTHER MEDICAL PROCEDURES, FETUS 1





O35.7XX9 ICD10 MATERNAL CARE FOR (SUSPECTED) DAMAGE TO FETUS BY OTHER MEDICAL PROCEDURES, OTHER FETUS

O35.8XX1 ICD10 MATERNAL CARE FOR OTHER (SUSPECTED) FETAL ABNORMALITY AND DAMAGE, FETUS 1





O35.8XX9 ICD10 MATERNAL CARE FOR OTHER (SUSPECTED) FETAL ABNORMALITY AND DAMAGE, OTHER FETUS

O35.9XX1 ICD10 MATERNAL CARE FOR (SUSPECTED) FETAL ABNORMALITY AND DAMAGE, UNSPECIFIED, FETUS 1





O35.9XX9 ICD10 MATERNAL CARE FOR (SUSPECTED) FETAL ABNORMALITY AND DAMAGE, UNSPECIFIED, OTHER FETUS

O36.0111 ICD10 MATERNAL CARE FOR ANTI-D [RH] ANTIBODIES, FIRST TRIMESTER, FETUS 1





O36.0119 ICD10 MATERNAL CARE FOR ANTI-D [RH] ANTIBODIES, FIRST TRIMESTER, OTHER FETUS

Proprietary

48

O36.0121 ICD10 MATERNAL CARE FOR ANTI-D [RH] ANTIBODIES, SECOND TRIMESTER, FETUS 1





O36.0129 ICD10 MATERNAL CARE FOR ANTI-D [RH] ANTIBODIES, SECOND TRIMESTER, OTHER FETUS

O36.0131 ICD10 MATERNAL CARE FOR ANTI-D [RH] ANTIBODIES, THIRD TRIMESTER, FETUS 1





O36.0139 ICD10 MATERNAL CARE FOR ANTI-D [RH] ANTIBODIES, THIRD TRIMESTER, OTHER FETUS

O36.0191 ICD10 MATERNAL CARE FOR ANTI-D [RH] ANTIBODIES, UNSPECIFIED TRIMESTER, FETUS 1





O36.0199 ICD10 MATERNAL CARE FOR ANTI-D [RH] ANTIBODIES, UNSPECIFIED TRIMESTER, OTHER FETUS

O36.0911 ICD10 MATERNAL CARE FOR OTHER RHESUS ISOIMMUNIZATION, FIRST TRIMESTER, FETUS 1





O36.0919 ICD10 MATERNAL CARE FOR OTHER RHESUS ISOIMMUNIZATION, FIRST TRIMESTER, OTHER FETUS

O36.0921 ICD10 MATERNAL CARE FOR OTHER RHESUS ISOIMMUNIZATION, SECOND TRIMESTER, FETUS 1





O36.0929 ICD10 MATERNAL CARE FOR OTHER RHESUS ISOIMMUNIZATION, SECOND TRIMESTER, OTHER FETUS

O36.0931 ICD10 MATERNAL CARE FOR OTHER RHESUS ISOIMMUNIZATION, THIRD TRIMESTER, FETUS 1





O36.0939 ICD10 MATERNAL CARE FOR OTHER RHESUS ISOIMMUNIZATION, THIRD TRIMESTER, OTHER FETUS

O36.0991 ICD10 MATERNAL CARE FOR OTHER RHESUS ISOIMMUNIZATION, UNSPECIFIED TRIMESTER, FETUS 1





O36.0999 ICD10 MATERNAL CARE FOR OTHER RHESUS ISOIMMUNIZATION, UNSPECIFIED TRIMESTER, OTHER FETUS

O36.1111 ICD10 MATERNAL CARE FOR ANTI-A SENSITIZATION, FIRST TRIMESTER, FETUS 1





O36.1119 ICD10 MATERNAL CARE FOR ANTI-A SENSITIZATION, FIRST TRIMESTER, OTHER FETUS

O36.1121 ICD10 MATERNAL CARE FOR ANTI-A SENSITIZATION, SECOND TRIMESTER, FETUS 1



Proprietary

49



O36.1129 ICD10 MATERNAL CARE FOR ANTI-A SENSITIZATION, SECOND TRIMESTER, OTHER FETUS

O36.1131 ICD10 MATERNAL CARE FOR ANTI-A SENSITIZATION, THIRD TRIMESTER, FETUS 1





O36.1139 ICD10 MATERNAL CARE FOR ANTI-A SENSITIZATION, THIRD TRIMESTER, OTHER FETUS

O36.1191 ICD10 MATERNAL CARE FOR ANTI-A SENSITIZATION, UNSPECIFIED TRIMESTER, FETUS 1





O36.1199 ICD10 MATERNAL CARE FOR ANTI-A SENSITIZATION, UNSPECIFIED TRIMESTER, OTHER FETUS

O36.1911 ICD10 MATERNAL CARE FOR OTHER ISOIMMUNIZATION, FIRST TRIMESTER, FETUS 1





O36.1919 ICD10 MATERNAL CARE FOR OTHER ISOIMMUNIZATION, FIRST TRIMESTER, OTHER FETUS

O36.1921 ICD10 MATERNAL CARE FOR OTHER ISOIMMUNIZATION, SECOND TRIMESTER, FETUS 1





O36.1929 ICD10 MATERNAL CARE FOR OTHER ISOIMMUNIZATION, SECOND TRIMESTER, OTHER FETUS

O36.1931 ICD10 MATERNAL CARE FOR OTHER ISOIMMUNIZATION, THIRD TRIMESTER, FETUS 1





O36.1939 ICD10 MATERNAL CARE FOR OTHER ISOIMMUNIZATION, THIRD TRIMESTER, OTHER FETUS

O36.1991 ICD10 MATERNAL CARE FOR OTHER ISOIMMUNIZATION, UNSPECIFIED TRIMESTER, FETUS 1





O36.1999 ICD10 MATERNAL CARE FOR OTHER ISOIMMUNIZATION, UNSPECIFIED TRIMESTER, OTHER FETUS

O36.20X1 ICD10 MATERNAL CARE FOR HYDROPS FETALIS, UNSPECIFIED TRIMESTER, FETUS 1





O36.20X9 ICD10 MATERNAL CARE FOR HYDROPS FETALIS, UNSPECIFIED TRIMESTER, OTHER FETUS

O36.21X1 ICD10 MATERNAL CARE FOR HYDROPS FETALIS, FIRST TRIMESTER, FETUS 1





O36.21X9 ICD10 MATERNAL CARE FOR HYDROPS FETALIS, FIRST TRIMESTER, OTHER FETUS

Proprietary

50

O36.22X1 ICD10 MATERNAL CARE FOR HYDROPS FETALIS, SECOND TRIMESTER, FETUS 1





O36.22X9 ICD10 MATERNAL CARE FOR HYDROPS FETALIS, SECOND TRIMESTER, OTHER FETUS

O36.23X1 ICD10 MATERNAL CARE FOR HYDROPS FETALIS, THIRD TRIMESTER, FETUS 1





O36.23X9 ICD10 MATERNAL CARE FOR HYDROPS FETALIS, THIRD TRIMESTER, OTHER FETUS

O36.4XX0 ICD10 MATERNAL CARE FOR INTRAUTERINE DEATH, NOT APPLICABLE OR UNSPECIFIED

O36.4XX1 ICD10 MATERNAL CARE FOR INTRAUTERINE DEATH, FETUS 1





O36.4XX9 ICD10 MATERNAL CARE FOR INTRAUTERINE DEATH, OTHER FETUS

O36.5111 ICD10 MATERNAL CARE FOR KNOWN OR SUSPECTED PLACENTAL INSUFFICIENCY, FIRST TRIMESTER, FETUS 1





O36.5119 ICD10 MATERNAL CARE FOR KNOWN OR SUSPECTED PLACENTAL INSUFFICIENCY, FIRST TRIMESTER, OTHER FETUS

O36.5121 ICD10 MATERNAL CARE FOR KNOWN OR SUSPECTED PLACENTAL INSUFFICIENCY, SECOND TRIMESTER, FETUS 1





O36.5129 ICD10 MATERNAL CARE FOR KNOWN OR SUSPECTED PLACENTAL INSUFFICIENCY, SECOND TRIMESTER, OTHER FETUS

O36.5131 ICD10 MATERNAL CARE FOR KNOWN OR SUSPECTED PLACENTAL INSUFFICIENCY, THIRD TRIMESTER, FETUS 1





O36.5139 ICD10 MATERNAL CARE FOR KNOWN OR SUSPECTED PLACENTAL INSUFFICIENCY, THIRD TRIMESTER, OTHER FETUS

O36.5191 ICD10 MATERNAL CARE FOR KNOWN OR SUSPECTED PLACENTAL INSUFFICIENCY, UNSPECIFIED TRIMESTER, FETUS 1





O36.5199 ICD10 MATERNAL CARE FOR KNOWN OR SUSPECTED PLACENTAL INSUFFICIENCY, UNSPECIFIED TRIMESTER, OTHER FETUS

O36.5911 ICD10 MATERNAL CARE FOR OTHER KNOWN OR SUSPECTED POOR FETAL GROWTH, FIRST TRIMESTER, FETUS 1





O36.5919 ICD10 MATERNAL CARE FOR OTHER KNOWN OR SUSPECTED POOR FETAL GROWTH, FIRST TRIMESTER, OTHER FETUS

O36.5921 ICD10 MATERNAL CARE FOR OTHER KNOWN OR SUSPECTED POOR FETAL GROWTH, SECOND TRIMESTER, FETUS 1


Proprietary

51




O36.5929 ICD10 MATERNAL CARE FOR OTHER KNOWN OR SUSPECTED POOR FETAL GROWTH, SECOND TRIMESTER, OTHER FETUS

O36.5931 ICD10 MATERNAL CARE FOR OTHER KNOWN OR SUSPECTED POOR FETAL GROWTH, THIRD TRIMESTER, FETUS 1





O36.5939 ICD10 MATERNAL CARE FOR OTHER KNOWN OR SUSPECTED POOR FETAL GROWTH, THIRD TRIMESTER, OTHER FETUS

O36.5991 ICD10 MATERNAL CARE FOR OTHER KNOWN OR SUSPECTED POOR FETAL GROWTH, UNSPECIFIED TRIMESTER, FETUS 1





O36.5999 ICD10 MATERNAL CARE FOR OTHER KNOWN OR SUSPECTED POOR FETAL GROWTH, UNSPECIFIED TRIMESTER, OTHER FETUS

O36.60X1 ICD10 MATERNAL CARE FOR EXCESSIVE FETAL GROWTH, UNSPECIFIED TRIMESTER, FETUS 1





O36.60X9 ICD10 MATERNAL CARE FOR EXCESSIVE FETAL GROWTH, UNSPECIFIED TRIMESTER, OTHER FETUS

O36.61X1 ICD10 MATERNAL CARE FOR EXCESSIVE FETAL GROWTH, FIRST TRIMESTER, FETUS 1





O36.61X9 ICD10 MATERNAL CARE FOR EXCESSIVE FETAL GROWTH, FIRST TRIMESTER, OTHER FETUS

O36.62X1 ICD10 MATERNAL CARE FOR EXCESSIVE FETAL GROWTH, SECOND TRIMESTER, FETUS 1





O36.62X9 ICD10 MATERNAL CARE FOR EXCESSIVE FETAL GROWTH, SECOND TRIMESTER, OTHER FETUS

O36.63X1 ICD10 MATERNAL CARE FOR EXCESSIVE FETAL GROWTH, THIRD TRIMESTER, FETUS 1





O36.63X9 ICD10 MATERNAL CARE FOR EXCESSIVE FETAL GROWTH, THIRD TRIMESTER, OTHER FETUS

O36.70X1 ICD10 MATERNAL CARE FOR VIABLE FETUS IN ABDOMINAL PREGNANCY, UNSPECIFIED TRIMESTER, FETUS 1





O36.70X9 ICD10 MATERNAL CARE FOR VIABLE FETUS IN ABDOMINAL PREGNANCY, UNSPECIFIED TRIMESTER, OTHER FETUS

O36.71X1 ICD10 MATERNAL CARE FOR VIABLE FETUS IN ABDOMINAL PREGNANCY, FIRST TRIMESTER, FETUS 1





Proprietary

52

O36.71X9 ICD10 MATERNAL CARE FOR VIABLE FETUS IN ABDOMINAL PREGNANCY, FIRST TRIMESTER, OTHER FETUS

O36.72X1 ICD10 MATERNAL CARE FOR VIABLE FETUS IN ABDOMINAL PREGNANCY, SECOND TRIMESTER, FETUS 1





O36.72X9 ICD10 MATERNAL CARE FOR VIABLE FETUS IN ABDOMINAL PREGNANCY, SECOND TRIMESTER, OTHER FETUS

O36.73X0 ICD10 MATERNAL CARE FOR VIABLE FETUS IN ABDOMINAL PREGNANCY, THIRD TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O36.73X1 ICD10 MATERNAL CARE FOR VIABLE FETUS IN ABDOMINAL PREGNANCY, THIRD TRIMESTER, FETUS 1





O36.73X9 ICD10 MATERNAL CARE FOR VIABLE FETUS IN ABDOMINAL PREGNANCY, THIRD TRIMESTER, OTHER FETUS

O36.80X1 ICD10 PREGNANCY WITH INCONCLUSIVE FETAL VIABILITY, FETUS 1





O36.80X9 ICD10 PREGNANCY WITH INCONCLUSIVE FETAL VIABILITY, OTHER FETUS

O36.8121 ICD10 DECREASED FETAL MOVEMENTS, SECOND TRIMESTER, FETUS 1





O36.8129 ICD10 DECREASED FETAL MOVEMENTS, SECOND TRIMESTER, OTHER FETUS

O36.8131 ICD10 DECREASED FETAL MOVEMENTS, THIRD TRIMESTER, FETUS 1





O36.8139 ICD10 DECREASED FETAL MOVEMENTS, THIRD TRIMESTER, OTHER FETUS

O36.8191 ICD10 DECREASED FETAL MOVEMENTS, UNSPECIFIED TRIMESTER, FETUS 1





O36.8199 ICD10 DECREASED FETAL MOVEMENTS, UNSPECIFIED TRIMESTER, OTHER FETUS

O36.8211 ICD10 FETAL ANEMIA AND THROMBOCYTOPENIA, FIRST TRIMESTER, FETUS 1





O36.8219 ICD10 FETAL ANEMIA AND THROMBOCYTOPENIA, FIRST TRIMESTER, OTHER FETUS

O36.8221 ICD10 FETAL ANEMIA AND THROMBOCYTOPENIA, SECOND TRIMESTER, FETUS 1





O36.8229 ICD10 FETAL ANEMIA AND THROMBOCYTOPENIA, SECOND TRIMESTER, OTHER FETUS

O36.8231 ICD10 FETAL ANEMIA AND THROMBOCYTOPENIA, THIRD TRIMESTER, FETUS 1

Proprietary

53





O36.8239 ICD10 FETAL ANEMIA AND THROMBOCYTOPENIA, THIRD TRIMESTER, OTHER FETUS

O36.8291 ICD10 FETAL ANEMIA AND THROMBOCYTOPENIA, UNSPECIFIED TRIMESTER, FETUS 1





O36.8299 ICD10 FETAL ANEMIA AND THROMBOCYTOPENIA, UNSPECIFIED TRIMESTER, OTHER FETUS

O36.8911 ICD10 MATERNAL CARE FOR OTHER SPECIFIED FETAL PROBLEMS, FIRST TRIMESTER, FETUS 1





O36.8919 ICD10 MATERNAL CARE FOR OTHER SPECIFIED FETAL PROBLEMS, FIRST TRIMESTER, OTHER FETUS

O36.8921 ICD10 MATERNAL CARE FOR OTHER SPECIFIED FETAL PROBLEMS, SECOND TRIMESTER, FETUS 1





O36.8929 ICD10 MATERNAL CARE FOR OTHER SPECIFIED FETAL PROBLEMS, SECOND TRIMESTER, OTHER FETUS

O36.8931 ICD10 MATERNAL CARE FOR OTHER SPECIFIED FETAL PROBLEMS, THIRD TRIMESTER, FETUS 1





O36.8939 ICD10 MATERNAL CARE FOR OTHER SPECIFIED FETAL PROBLEMS, THIRD TRIMESTER, OTHER FETUS

O36.8991 ICD10 MATERNAL CARE FOR OTHER SPECIFIED FETAL PROBLEMS, UNSPECIFIED TRIMESTER, FETUS 1





O36.8999 ICD10 MATERNAL CARE FOR OTHER SPECIFIED FETAL PROBLEMS, UNSPECIFIED TRIMESTER, OTHER FETUS

O36.90X1 ICD10 MATERNAL CARE FOR FETAL PROBLEM, UNSPECIFIED, UNSPECIFIED TRIMESTER, FETUS 1





O36.90X9 ICD10 MATERNAL CARE FOR FETAL PROBLEM, UNSPECIFIED, UNSPECIFIED TRIMESTER, OTHER FETUS

O36.91X1 ICD10 MATERNAL CARE FOR FETAL PROBLEM, UNSPECIFIED, FIRST TRIMESTER, FETUS 1





O36.91X9 ICD10 MATERNAL CARE FOR FETAL PROBLEM, UNSPECIFIED, FIRST TRIMESTER, OTHER FETUS

O36.92X1 ICD10 MATERNAL CARE FOR FETAL PROBLEM, UNSPECIFIED, SECOND TRIMESTER, FETUS 1




Proprietary

54


O36.92X9 ICD10 MATERNAL CARE FOR FETAL PROBLEM, UNSPECIFIED, SECOND TRIMESTER, OTHER FETUS

O36.93X1 ICD10 MATERNAL CARE FOR FETAL PROBLEM, UNSPECIFIED, THIRD TRIMESTER, FETUS 1





O36.93X9 ICD10 MATERNAL CARE FOR FETAL PROBLEM, UNSPECIFIED, THIRD TRIMESTER, OTHER FETUS

O40.1XX1 ICD10 POLYHYDRAMNIOS, FIRST TRIMESTER, FETUS 1





O40.1XX9 ICD10 POLYHYDRAMNIOS, FIRST TRIMESTER, OTHER FETUS

O40.2XX1 ICD10 POLYHYDRAMNIOS, SECOND TRIMESTER, FETUS 1





O40.2XX9 ICD10 POLYHYDRAMNIOS, SECOND TRIMESTER, OTHER FETUS

O40.3XX1 ICD10 POLYHYDRAMNIOS, THIRD TRIMESTER, FETUS 1





O40.3XX9 ICD10 POLYHYDRAMNIOS, THIRD TRIMESTER, OTHER FETUS

O40.9XX1 ICD10 POLYHYDRAMNIOS, UNSPECIFIED TRIMESTER, FETUS 1





O40.9XX9 ICD10 POLYHYDRAMNIOS, UNSPECIFIED TRIMESTER, OTHER FETUS

O41.00X1 ICD10 OLIGOHYDRAMNIOS, UNSPECIFIED TRIMESTER, FETUS 1





O41.00X9 ICD10 OLIGOHYDRAMNIOS, UNSPECIFIED TRIMESTER, OTHER FETUS

O41.01X1 ICD10 OLIGOHYDRAMNIOS, FIRST TRIMESTER, FETUS 1





O41.01X9 ICD10 OLIGOHYDRAMNIOS, FIRST TRIMESTER, OTHER FETUS

O41.02X1 ICD10 OLIGOHYDRAMNIOS, SECOND TRIMESTER, FETUS 1





O41.02X9 ICD10 OLIGOHYDRAMNIOS, SECOND TRIMESTER, OTHER FETUS

O41.03X1 ICD10 OLIGOHYDRAMNIOS, THIRD TRIMESTER, FETUS 1

Proprietary

55





O41.03X9 ICD10 OLIGOHYDRAMNIOS, THIRD TRIMESTER, OTHER FETUS

O41.1011 ICD10 INFECTION OF AMNIOTIC SAC AND MEMBRANES, UNSPECIFIED, FIRST TRIMESTER, FETUS 1





O41.1019 ICD10 INFECTION OF AMNIOTIC SAC AND MEMBRANES, UNSPECIFIED, FIRST TRIMESTER, OTHER FETUS

O41.1021 ICD10 INFECTION OF AMNIOTIC SAC AND MEMBRANES, UNSPECIFIED, SECOND TRIMESTER, FETUS 1





O41.1029 ICD10 INFECTION OF AMNIOTIC SAC AND MEMBRANES, UNSPECIFIED, SECOND TRIMESTER, OTHER FETUS

O41.1031 ICD10 INFECTION OF AMNIOTIC SAC AND MEMBRANES, UNSPECIFIED, THIRD TRIMESTER, FETUS 1





O41.1039 ICD10 INFECTION OF AMNIOTIC SAC AND MEMBRANES, UNSPECIFIED, THIRD TRIMESTER, OTHER FETUS

O41.1091 ICD10 INFECTION OF AMNIOTIC SAC AND MEMBRANES, UNSPECIFIED, UNSPECIFIED TRIMESTER, FETUS 1





O41.1099 ICD10 INFECTION OF AMNIOTIC SAC AND MEMBRANES, UNSPECIFIED, UNSPECIFIED TRIMESTER, OTHER FETUS

O41.1211 ICD10 CHORIOAMNIONITIS, FIRST TRIMESTER, FETUS 1





O41.1219 ICD10 CHORIOAMNIONITIS, FIRST TRIMESTER, OTHER FETUS

O41.1221 ICD10 CHORIOAMNIONITIS, SECOND TRIMESTER, FETUS 1





O41.1229 ICD10 CHORIOAMNIONITIS, SECOND TRIMESTER, OTHER FETUS

O41.1231 ICD10 CHORIOAMNIONITIS, THIRD TRIMESTER, FETUS 1





O41.1239 ICD10 CHORIOAMNIONITIS, THIRD TRIMESTER, OTHER FETUS

O41.1291 ICD10 CHORIOAMNIONITIS, UNSPECIFIED TRIMESTER, FETUS 1




Proprietary

56


O41.1299 ICD10 CHORIOAMNIONITIS, UNSPECIFIED TRIMESTER, OTHER FETUS

O41.1411 ICD10 PLACENTITIS, FIRST TRIMESTER, FETUS 1





O41.1419 ICD10 PLACENTITIS, FIRST TRIMESTER, OTHER FETUS

O41.1421 ICD10 PLACENTITIS, SECOND TRIMESTER, FETUS 1





O41.1429 ICD10 PLACENTITIS, SECOND TRIMESTER, OTHER FETUS

O41.1431 ICD10 PLACENTITIS, THIRD TRIMESTER, FETUS 1





O41.1439 ICD10 PLACENTITIS, THIRD TRIMESTER, OTHER FETUS

O41.1491 ICD10 PLACENTITIS, UNSPECIFIED TRIMESTER, FETUS 1





O41.1499 ICD10 PLACENTITIS, UNSPECIFIED TRIMESTER, OTHER FETUS

O41.8X11 ICD10 OTHER SPECIFIED DISORDERS OF AMNIOTIC FLUID AND MEMBRANES, FIRST TRIMESTER, FETUS 1





O41.8X19 ICD10 OTHER SPECIFIED DISORDERS OF AMNIOTIC FLUID AND MEMBRANES, FIRST TRIMESTER, OTHER FETUS

O41.8X21 ICD10 OTHER SPECIFIED DISORDERS OF AMNIOTIC FLUID AND MEMBRANES, SECOND TRIMESTER, FETUS 1





O41.8X29 ICD10 OTHER SPECIFIED DISORDERS OF AMNIOTIC FLUID AND MEMBRANES, SECOND TRIMESTER, OTHER FETUS

O41.8X31 ICD10 OTHER SPECIFIED DISORDERS OF AMNIOTIC FLUID AND MEMBRANES, THIRD TRIMESTER, FETUS 1





O41.8X39 ICD10 OTHER SPECIFIED DISORDERS OF AMNIOTIC FLUID AND MEMBRANES, THIRD TRIMESTER, OTHER FETUS

O41.8X91 ICD10 OTHER SPECIFIED DISORDERS OF AMNIOTIC FLUID AND MEMBRANES, UNSPECIFIED TRIMESTER, FETUS 1





O41.8X99 ICD10 OTHER SPECIFIED DISORDERS OF AMNIOTIC FLUID AND MEMBRANES, UNSPECIFIED TRIMESTER, OTHER FETUS

O41.90X1 ICD10 DISORDER OF AMNIOTIC FLUID AND MEMBRANES, UNSPECIFIED, UNSPECIFIED TRIMESTER, FETUS 1

Proprietary

57





O41.90X9 ICD10 DISORDER OF AMNIOTIC FLUID AND MEMBRANES, UNSPECIFIED, UNSPECIFIED TRIMESTER, OTHER FETUS

O41.91X1 ICD10 DISORDER OF AMNIOTIC FLUID AND MEMBRANES, UNSPECIFIED, FIRST TRIMESTER, FETUS 1





O41.91X9 ICD10 DISORDER OF AMNIOTIC FLUID AND MEMBRANES, UNSPECIFIED, FIRST TRIMESTER, OTHER FETUS

O41.92X1 ICD10 DISORDER OF AMNIOTIC FLUID AND MEMBRANES, UNSPECIFIED, SECOND TRIMESTER, FETUS 1





O41.92X9 ICD10 DISORDER OF AMNIOTIC FLUID AND MEMBRANES, UNSPECIFIED, SECOND TRIMESTER, OTHER FETUS

O41.93X1 ICD10 DISORDER OF AMNIOTIC FLUID AND MEMBRANES, UNSPECIFIED, THIRD TRIMESTER, FETUS 1





O41.93X9 ICD10 DISORDER OF AMNIOTIC FLUID AND MEMBRANES, UNSPECIFIED, THIRD TRIMESTER, OTHER FETUS

O43.212 ICD10 PLACENTA ACCRETA, SECOND TRIMESTER

O43.213 ICD10 PLACENTA ACCRETA, THIRD TRIMESTER

O43.219 ICD10 PLACENTA ACCRETA, UNSPECIFIED TRIMESTER

O43.222 ICD10 PLACENTA INCRETA, SECOND TRIMESTER

O43.223 ICD10 PLACENTA INCRETA, THIRD TRIMESTER

O43.229 ICD10 PLACENTA INCRETA, UNSPECIFIED TRIMESTER

O43.232 ICD10 PLACENTA PERCRETA, SECOND TRIMESTER

O43.233 ICD10 PLACENTA PERCRETA, THIRD TRIMESTER

O43.239 ICD10 PLACENTA PERCRETA, UNSPECIFIED TRIMESTER

O44.00 ICD10 COMPLETE PLACENTA PREVIA NOS OR WITHOUT HEMORRHAGE, UNSPECIFIED TRIMESTER

O44.02 ICD10 COMPLETE PLACENTA PREVIA NOS OR WITHOUT HEMORRHAGE, SECOND TRIMESTER

O44.03 ICD10 COMPLETE PLACENTA PREVIA NOS OR WITHOUT HEMORRHAGE, THIRD TRIMESTER

O44.10 ICD10 COMPLETE PLACENTA PREVIA WITH HEMORRHAGE, UNSPECIFIED TRIMESTER

O44.12 ICD10 COMPLETE PLACENTA PREVIA WITH HEMORRHAGE, SECOND TRIMESTER

O44.13 ICD10 COMPLETE PLACENTA PREVIA WITH HEMORRHAGE, THIRD TRIMESTER

O44.20 ICD10 PARTIAL PLACENTA PREVIA NOS OR WITHOUT HEMORRHAGE, UNSPECIFIED TRIMESTER

O44.22 ICD10 PARTIAL PLACENTA PREVIA NOS OR WITHOUT HEMORRHAGE, SECOND TRIMESTER

O44.23 ICD10 PARTIAL PLACENTA PREVIA NOS OR WITHOUT HEMORRHAGE, THIRD TRIMESTER

O44.30 ICD10 PARTIAL PLACENTA PREVIA WITH HEMORRHAGE, UNSPECIFIED TRIMESTER

O44.32 ICD10 PARTIAL PLACENTA PREVIA WITH HEMORRHAGE, SECOND TRIMESTER

O44.33 ICD10 PARTIAL PLACENTA PREVIA WITH HEMORRHAGE, THIRD TRIMESTER

O44.40 ICD10 LOW LYING PLACENTA NOS OR WITHOUT HEMORRHAGE, UNSPECIFIED TRIMESTER

O44.42 ICD10 LOW LYING PLACENTA NOS OR WITHOUT HEMORRHAGE, SECOND TRIMESTER

O44.43 ICD10 LOW LYING PLACENTA NOS OR WITHOUT HEMORRHAGE, THIRD TRIMESTER

O44.50 ICD10 LOW LYING PLACENTA WITH HEMORRHAGE, UNSPECIFIED TRIMESTER

O44.52 ICD10 LOW LYING PLACENTA WITH HEMORRHAGE, SECOND TRIMESTER

O44.53 ICD10 LOW LYING PLACENTA WITH HEMORRHAGE, THIRD TRIMESTER

O45.002 ICD10 PREMATURE SEPARATION OF PLACENTA WITH COAGULATION DEFECT, UNSPECIFIED, SECOND TRIMESTER

Proprietary

58

O45.003 ICD10 PREMATURE SEPARATION OF PLACENTA WITH COAGULATION DEFECT, UNSPECIFIED, THIRD TRIMESTER

O45.009 ICD10 PREMATURE SEPARATION OF PLACENTA WITH COAGULATION DEFECT, UNSPECIFIED, UNSPECIFIED TRIMESTER

O45.012 ICD10 PREMATURE SEPARATION OF PLACENTA WITH AFIBRINOGENEMIA, SECOND TRIMESTER

O45.013 ICD10 PREMATURE SEPARATION OF PLACENTA WITH AFIBRINOGENEMIA, THIRD TRIMESTER

O45.019 ICD10 PREMATURE SEPARATION OF PLACENTA WITH AFIBRINOGENEMIA, UNSPECIFIED TRIMESTER

O45.022 ICD10 PREMATURE SEPARATION OF PLACENTA WITH DISSEMINATED INTRAVASCULAR COAGULATION, SECOND TRIMESTER

O45.023 ICD10 PREMATURE SEPARATION OF PLACENTA WITH DISSEMINATED INTRAVASCULAR COAGULATION, THIRD TRIMESTER

O45.029 ICD10 PREMATURE SEPARATION OF PLACENTA WITH DISSEMINATED INTRAVASCULAR COAGULATION, UNSPECIFIED TRIMESTER

O45.092 ICD10 PREMATURE SEPARATION OF PLACENTA WITH OTHER COAGULATION DEFECT, SECOND TRIMESTER

O45.093 ICD10 PREMATURE SEPARATION OF PLACENTA WITH OTHER COAGULATION DEFECT, THIRD TRIMESTER

O45.099 ICD10 PREMATURE SEPARATION OF PLACENTA WITH OTHER COAGULATION DEFECT, UNSPECIFIED TRIMESTER

O60.10X0 ICD10 PRETERM LABOR WITH PRETERM DELIVERY, UNSPECIFIED TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O60.10X1 ICD10 PRETERM LABOR WITH PRETERM DELIVERY, UNSPECIFIED TRIMESTER, FETUS 1





O60.10X9 ICD10 PRETERM LABOR WITH PRETERM DELIVERY, UNSPECIFIED TRIMESTER, OTHER FETUS

O60.12X0 ICD10 PRETERM LABOR SECOND TRIMESTER WITH PRETERM DELIVERY SECOND TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O60.12X1 ICD10 PRETERM LABOR SECOND TRIMESTER WITH PRETERM DELIVERY SECOND TRIMESTER, FETUS 1





O60.12X9 ICD10 PRETERM LABOR SECOND TRIMESTER WITH PRETERM DELIVERY SECOND TRIMESTER, OTHER FETUS

O60.13X0 ICD10 PRETERM LABOR SECOND TRIMESTER WITH PRETERM DELIVERY THIRD TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O60.13X1 ICD10 PRETERM LABOR SECOND TRIMESTER WITH PRETERM DELIVERY THIRD TRIMESTER, FETUS 1





O60.13X9 ICD10 PRETERM LABOR SECOND TRIMESTER WITH PRETERM DELIVERY THIRD TRIMESTER, OTHER FETUS

O60.14X0 ICD10 PRETERM LABOR THIRD TRIMESTER WITH PRETERM DELIVERY THIRD TRIMESTER, NOT APPLICABLE OR UNSPECIFIED

O60.14X1 ICD10 PRETERM LABOR THIRD TRIMESTER WITH PRETERM DELIVERY THIRD TRIMESTER, FETUS 1





O60.14X9 ICD10 PRETERM LABOR THIRD TRIMESTER WITH PRETERM DELIVERY THIRD TRIMESTER, OTHER FETUS

O60.20X1 ICD10 TERM DELIVERY WITH PRETERM LABOR, UNSPECIFIED TRIMESTER, FETUS 1





O60.20X9 ICD10 TERM DELIVERY WITH PRETERM LABOR, UNSPECIFIED TRIMESTER, OTHER FETUS

O60.22X1 ICD10 TERM DELIVERY WITH PRETERM LABOR, SECOND TRIMESTER, FETUS 1





O60.22X9 ICD10 TERM DELIVERY WITH PRETERM LABOR, SECOND TRIMESTER, OTHER FETUS

Proprietary

59

O60.23X1 ICD10 TERM DELIVERY WITH PRETERM LABOR, THIRD TRIMESTER, FETUS 1





O60.23X9 ICD10 TERM DELIVERY WITH PRETERM LABOR, THIRD TRIMESTER, OTHER FETUS

O63.2 ICD10 DELAYED DELIVERY OF SECOND TWIN, TRIPLET, ETC.

O64.0XX0 ICD10 OBSTRUCTED LABOR DUE TO INCOMPLETE ROTATION OF FETAL HEAD, NOT APPLICABLE OR UNSPECIFIED

O64.0XX1 ICD10 OBSTRUCTED LABOR DUE TO INCOMPLETE ROTATION OF FETAL HEAD, FETUS 1





O64.0XX9 ICD10 OBSTRUCTED LABOR DUE TO INCOMPLETE ROTATION OF FETAL HEAD, OTHER FETUS

O64.1XX0 ICD10 OBSTRUCTED LABOR DUE TO BREECH PRESENTATION, NOT APPLICABLE OR UNSPECIFIED

O64.1XX1 ICD10 OBSTRUCTED LABOR DUE TO BREECH PRESENTATION, FETUS 1





O64.1XX9 ICD10 OBSTRUCTED LABOR DUE TO BREECH PRESENTATION, OTHER FETUS

O64.2XX0 ICD10 OBSTRUCTED LABOR DUE TO FACE PRESENTATION, NOT APPLICABLE OR UNSPECIFIED

O64.2XX1 ICD10 OBSTRUCTED LABOR DUE TO FACE PRESENTATION, FETUS 1





O64.2XX9 ICD10 OBSTRUCTED LABOR DUE TO FACE PRESENTATION, OTHER FETUS

O64.3XX0 ICD10 OBSTRUCTED LABOR DUE TO BROW PRESENTATION, NOT APPLICABLE OR UNSPECIFIED

O64.3XX1 ICD10 OBSTRUCTED LABOR DUE TO BROW PRESENTATION, FETUS 1





O64.3XX9 ICD10 OBSTRUCTED LABOR DUE TO BROW PRESENTATION, OTHER FETUS

O64.4XX0 ICD10 OBSTRUCTED LABOR DUE TO SHOULDER PRESENTATION, NOT APPLICABLE OR UNSPECIFIED

O64.4XX1 ICD10 OBSTRUCTED LABOR DUE TO SHOULDER PRESENTATION, FETUS 1





O64.4XX9 ICD10 OBSTRUCTED LABOR DUE TO SHOULDER PRESENTATION, OTHER FETUS

O64.5XX0 ICD10 OBSTRUCTED LABOR DUE TO COMPOUND PRESENTATION, NOT APPLICABLE OR UNSPECIFIED

O64.5XX1 ICD10 OBSTRUCTED LABOR DUE TO COMPOUND PRESENTATION, FETUS 1





O64.5XX9 ICD10 OBSTRUCTED LABOR DUE TO COMPOUND PRESENTATION, OTHER FETUS

O64.8XX1 ICD10 OBSTRUCTED LABOR DUE TO OTHER MALPOSITION AND MALPRESENTATION, FETUS 1


Proprietary

60




O64.8XX9 ICD10 OBSTRUCTED LABOR DUE TO OTHER MALPOSITION AND MALPRESENTATION, OTHER FETUS

O64.9XX1 ICD10 OBSTRUCTED LABOR DUE TO MALPOSITION AND MALPRESENTATION, UNSPECIFIED, FETUS 1





O64.9XX9 ICD10 OBSTRUCTED LABOR DUE TO MALPOSITION AND MALPRESENTATION, UNSPECIFIED, OTHER FETUS

O66.1 ICD10 OBSTRUCTED LABOR DUE TO LOCKED TWINS

O66.41 ICD10 FAILED ATTEMPTED VAGINAL BIRTH AFTER PREVIOUS CESAREAN DELIVERY

O66.5 ICD10 ATTEMPTED APPLICATION OF VACUUM EXTRACTOR AND FORCEPS

O66.6 ICD10 OBSTRUCTED LABOR DUE TO OTHER MULTIPLE FETUSES

O69.0XX0 ICD10 LABOR AND DELIVERY COMPLICATED BY PROLAPSE OF CORD, NOT APPLICABLE OR UNSPECIFIED

O69.0XX0 ICD10 LABOR AND DELIVERY COMPLICATED BY PROLAPSE OF CORD, NOT APPLICABLE OR UNSPECIFIED

O69.0XX1 ICD10 LABOR AND DELIVERY COMPLICATED BY PROLAPSE OF CORD, FETUS 1





O69.0XX9 ICD10 LABOR AND DELIVERY COMPLICATED BY PROLAPSE OF CORD, OTHER FETUS

O69.1XX1 ICD10 LABOR AND DELIVERY COMPLICATED BY CORD AROUND NECK, WITH COMPRESSION, FETUS 1





O69.1XX9 ICD10 LABOR AND DELIVERY COMPLICATED BY CORD AROUND NECK, WITH COMPRESSION, OTHER FETUS

O69.2XX1 ICD10 LABOR AND DELIVERY COMPLICATED BY OTHER CORD ENTANGLEMENT, WITH COMPRESSION, FETUS 1





O69.2XX9 ICD10 LABOR AND DELIVERY COMPLICATED BY OTHER CORD ENTANGLEMENT, WITH COMPRESSION, OTHER FETUS

O69.3XX1 ICD10 LABOR AND DELIVERY COMPLICATED BY SHORT CORD, FETUS 1





O69.3XX9 ICD10 LABOR AND DELIVERY COMPLICATED BY SHORT CORD, OTHER FETUS

O69.4XX0 ICD10 LABOR AND DELIVERY COMPLICATED BY VASA PREVIA, NOT APPLICABLE OR UNSPECIFIED

O69.4XX1 ICD10 LABOR AND DELIVERY COMPLICATED BY VASA PREVIA, FETUS 1





O69.4XX9 ICD10 LABOR AND DELIVERY COMPLICATED BY VASA PREVIA, OTHER FETUS

O69.5XX1 ICD10 LABOR AND DELIVERY COMPLICATED BY VASCULAR LESION OF CORD, FETUS 1




Proprietary

61


O69.5XX9 ICD10 LABOR AND DELIVERY COMPLICATED BY VASCULAR LESION OF CORD, OTHER FETUS

O69.81X1 ICD10 LABOR AND DELIVERY COMPLICATED BY CORD AROUND NECK, WITHOUT COMPRESSION, FETUS 1





O69.81X9 ICD10 LABOR AND DELIVERY COMPLICATED BY CORD AROUND NECK, WITHOUT COMPRESSION, OTHER FETUS

O69.82X1 ICD10 LABOR AND DELIVERY COMPLICATED BY OTHER CORD ENTANGLEMENT, WITHOUT COMPRESSION, FETUS 1





O69.82X9 ICD10 LABOR AND DELIVERY COMPLICATED BY OTHER CORD ENTANGLEMENT, WITHOUT COMPRESSION, OTHER FETUS

O69.89X1 ICD10 LABOR AND DELIVERY COMPLICATED BY OTHER CORD COMPLICATIONS, FETUS 1





O69.89X9 ICD10 LABOR AND DELIVERY COMPLICATED BY OTHER CORD COMPLICATIONS, OTHER FETUS

O69.9XX1 ICD10 LABOR AND DELIVERY COMPLICATED BY CORD COMPLICATION, UNSPECIFIED, FETUS 1





O69.9XX9 ICD10 LABOR AND DELIVERY COMPLICATED BY CORD COMPLICATION, UNSPECIFIED, OTHER FETUS

O71.00 ICD10 RUPTURE OF UTERUS BEFORE ONSET OF LABOR, UNSPECIFIED TRIMESTER

O71.02 ICD10 RUPTURE OF UTERUS BEFORE ONSET OF LABOR, SECOND TRIMESTER

O71.03 ICD10 RUPTURE OF UTERUS BEFORE ONSET OF LABOR, THIRD TRIMESTER

O71.1 ICD10 RUPTURE OF UTERUS DURING LABOR

O98.711 ICD10 HUMAN IMMUNODEFICIENCY VIRUS HIV DISEASE COMPLICATING PREGNANCY, FIRST TRIMESTER

O98.712 ICD10 HUMAN IMMUNODEFICIENCY VIRUS HIV DISEASE COMPLICATING PREGNANCY, SECOND TRIMESTER

O98.713 ICD10 HUMAN IMMUNODEFICIENCY VIRUS HIV DISEASE COMPLICATING PREGNANCY, THIRD TRIMESTER

O98.719 ICD10 HUMAN IMMUNODEFICIENCY VIRUS HIV DISEASE COMPLICATING PREGNANCY, UNSPECIFIED TRIMESTER

O98.72 ICD10 HUMAN IMMUNODEFICIENCY VIRUS HIV DISEASE COMPLICATING CHILDBIRTH

O98.73 ICD10 HUMAN IMMUNODEFICIENCY VIRUS HIV DISEASE COMPLICATING THE PUERPERIUM

O99.411 ICD10 DISEASES OF THE CIRCULATORY SYSTEM COMPLICATING PREGNANCY, FIRST TRIMESTER

O99.412 ICD10 DISEASES OF THE CIRCULATORY SYSTEM COMPLICATING PREGNANCY, SECOND TRIMESTER

O99.413 ICD10 DISEASES OF THE CIRCULATORY SYSTEM COMPLICATING PREGNANCY, THIRD TRIMESTER

O99.419 ICD10 DISEASES OF THE CIRCULATORY SYSTEM COMPLICATING PREGNANCY, UNSPECIFIED TRIMESTER

O99.42 ICD10 DISEASES OF THE CIRCULATORY SYSTEM COMPLICATING CHILDBIRTH

O99.43 ICD10 DISEASES OF THE CIRCULATORY SYSTEM COMPLICATING THE PUERPERIUM

P01.5 ICD10 NEWBORN (SUSPECTED TO BE) AFFECTED BY MULTIPLE PREGNANCY

Z21 ICD10 ASYMPTOMATIC HUMAN IMMUNODEFICIENCY VIRUS [HIV] INFECTION STATUS

Z37.1 ICD10 SINGLE STILLBIRTH

Z37.2 ICD10 TWINS, BOTH LIVEBORN

Z37.3 ICD10 TWINS, ONE LIVEBORN AND ONE STILLBORN

Z37.4 ICD10 TWINS, BOTH STILLBORN

Z37.50 ICD10 MULTIPLE BIRTHS, UNSPECIFIED, ALL LIVEBORN

Z37.51 ICD10 TRIPLETS, ALL LIVEBORN

Z37.52 ICD10 QUADRUPLETS, ALL LIVEBORN

Proprietary

62

Z37.53 ICD10 QUINTUPLETS, ALL LIVEBORN

Z37.54 ICD10 SEXTUPLETS, ALL LIVEBORN

Z37.59 ICD10 OTHER MULTIPLE BIRTHS, ALL LIVEBORN

Z37.60 ICD10 MULTIPLE BIRTHS, UNSPECIFIED, SOME LIVEBORN

Z37.61 ICD10 TRIPLETS, SOME LIVEBORN

Z37.62 ICD10 QUADRUPLETS, SOME LIVEBORN

Z37.63 ICD10 QUINTUPLETS, SOME LIVEBORN

Z37.64 ICD10 SEXTUPLETS, SOME LIVEBORN

Z37.69 ICD10 OTHER MULTIPLE BIRTHS, SOME LIVEBORN

Z37.7 ICD10 OTHER MULTIPLE BIRTHS, ALL STILLBORN

Z3A.09 ICD10 9 WEEKS GESTATION OF PREGNANCY




























Z87.74 ICD10 PERSONAL HISTORY OF (CORRECTED) CONGENITAL MALFORMATIONS OF HEART AND CIRCULATORY SYSTEM

O14.14, ICD10 SEVERE PRE-ECLAMPSIA COMPLICATING CHILDBIRTH

O00.212 ICD10DX Left ovarian pregnancy with intrauterine pregnancy

O30.131 ICD10DX TRIPLET PREGNANCY, TRICHORIONIC/TRIAMNIOTIC, FIRST TRIMESTER

O30.132 ICD10DX TRIPLET PREGNANCY, TRICHORIONIC/TRIAMNIOTIC,SECOND TRIMESTER

O30.133 ICD10DX TRIPLET PREGNANCY, TRICHORIONIC/TRIAMNIOTIC, THIRD TRIMESTER

O30.139 ICD10DX TRIPLET PREGNANCY, TRICHORIONIC/TRIAMNIOTIC, UNSPECIFIED TRIMESTER

O30.231 ICD10DX QUADRUPLET PREGNANCY, QUADRACHORIONIC/QUADRA-AMNIOTIC, FIRST TRIMESTER

O30.232 ICD10DX QUADRUPLET PREGNANCY, QUADRACHORIONIC/QUADRA-AMNIOTIC, SECOND TRIMESTER

O30.233 ICD10DX QUADRUPLET PREGNANCY, QUADRACHORIONIC/QUADRA-AMNIOTIC, THIRD TRIMESTER

O30.239 ICD10DX QUADRUPLET PREGNANCY, QUADRACHORIONIC/QUADRA-AMNIOTIC, UNSPECIFIED TRIMESTER

O30.831 ICD10DX OTHER SPECIFIED MULTIPLE GESTATION, NUMBER OF CHORIONS AND AMNIONS ARE BOTH EQUAL TO THE NUMBER OF FETUSES, FIRST TRIMESTER

Proprietary

63

O30.832 ICD10DX OTHER SPECIFIED MULTIPLE GESTATION, NUMBER OF CHORIONS AND AMNIONS ARE BOTH EQUAL TO THE NUMBER OF FETUSES, SECOND TRIMESTER

O30.833 ICD10DX OTHER SPECIFIED MULTIPLE GESTATION, NUMBER OF CHORIONS AND AMNIONS ARE BOTH EQUAL TO THE NUMBER OF FETUSES, THIRD TRIMESTER

O30.839 ICD10DX OTHER SPECIFIED MULTIPLE GESTATION, NUMBER OF CHORIONS AND AMNIONS ARE BOTH EQUAL TO THE NUMBER OF FETUSES, UNSPECIFIEDTRIMESTER

Appendix H: General OB/GYN Subspecialty inclusion logic

Proprietary

64

Subspecialty Diagnoses group inclusion Inclusion

threshold1

Reproductive Endocrinology

and Infertility

Female infertility 10%

Female Pelvic Medicine and

Reconstructive Surgery

Urologic disorders – other 13%

Maternal-Fetal Medicine Fetal abnormality complicating pregnancy

Complicated pregnancy - other

36%

Complex Family Planning Abortion 12%

Gynecologic Oncology +

Endometriosis Gynecology

Gynecologic cancer

Endometriosis

9%

General OBGYN Gynecologic examination

Female birth control

Uterine disorders

Gynecologic disorders - other

Ovarian/tube/menopause disorders

1Attribution threshold = % of total claims is associated with subspecialty-specific diagnosis group(s)

Aetna is the brand name used for products and services provided by one or more of the Aetna

group of subsidiary companies, including Aetna Life Insurance Company and its affiliates

(Aetna).

©2021 Aetna Inc. 86.4100.01.01 (10/22)

aetna smart compare ob/gyn 2022 - full designation methodology

Documents