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Appendix A1: Primary Term Singleton Vertex Cesarean Delivery Rate(WSHA Roadmap Measure)Measure and Code SpecificationsDRAFT – based on AHRQ DRAFT Measure Specifications for IQI 33 Primary Cesarean Delivery Rate– Uncomplicated (v. 5.0) with WSHA Roadmap addition of Gestational Age at Delivery < 37 weeks to Exclusion listThese measure specifications will be updated when AHRQ finalizes the specifications code list.Description First-time Cesarean deliveries without a hysterotomy procedure per 100 deliveries. Excludes deliveries with abnormal presentation, preterm delivery < 37 weeks gestational age at delivery, fetal death, and multiple gestation diagnoses. Numerator Discharges, among cases meeting the inclusion and exclusion rules for the denominator, with either: ? DRG or MS-DRG or ICD-10 procedure codes for Cesarean delivery; or ? any-listed ICD-10 procedure codes for Cesarean delivery without any-listed ICD-10 procedure code for hysterotomyInclude: Cesarean Delivery Procedure Codes ICD-10-PCS10D00Z0Extraction of Products of Conception, Classical, Open Approach10C00Z1Extraction of Products of Conception, Low Cervical, Open Approach10D00Z2Extraction of Products of Conception, Extraperitoneal, Open ApproachExclude: Hysterotomy Procedure Codes ICD-10-PCS10A00ZZAbortion of Products of Conception, Open Approach10A03ZZAbortion of Products of Conception, Percutaneous Approach10Z04ZZAbortion of Products of Conception, Percutaneous Endoscopic ApproachDenominator - INCLUDE all deliveries, identified by DRG, MS-DRG or ICD-10-CM codesICD-10-CM Delivery CodesFrom Joint Commission Appendix A Table 11.01.1 Delivery CodesCode Shortened Description 10D00Z0 Extraction of Products of Conception, Classical, Open Approach 10D00Z1 Extraction of Products of Conception, Low Cervical, Open Approach 10D00Z2 Extraction of Products of Conception, Extraperitoneal, Open Approach 10D07Z3 Extraction of Products of Conception, Low Forceps, Via Natural or Artificial Opening 10D07Z4 Extraction of Products of Conception, Mid Forceps, Via Natural or Artificial Opening 10D07Z5 Extraction of Products of Conception, High Forceps, Via Natural or Artificial Opening 10D07Z6 Extraction of Products of Conception, Vacuum, Via Natural or Artificial Opening 10D07Z7 Extraction of Products of Conception, Internal Version, Via Natural or Artificial Opening 10D07Z8 Extraction of Products of Conception, Other, Via Natural or Artificial Opening 10E0XZZ Delivery of Products of Conception, External Approach EXCLUDE deliveries:With gestational age at delivery < 37 weeks (found in supplemental perinatal data)With any listed ICD-10-CM diagnosis code for previous Cesarean delivery: 03421 (Maternal care for scar from previous cesarean delivery), 06641 (Failed attempted vaginal birth after previous cesarean delivery)With any of ICD-10-CM diagnosis codes for AHRQ Contraindications to Vaginal Delivery diagnosis (abnormal presentation, preterm, fetal death, or multiple gestation, found in Primary TSV C-section IQI 33 Appendix A)NOTE: When Washington State birth certificate data is available add to exclusions: “History of previous cesarean delivery “ (field #57.7 on WA State Birth Filing Form)Url for AHRQ Inpatient Quality Indicators website: ................
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