Appendix 1. CDC Severe Maternal Morbidity Indicators and ...

Appendix 1. CDC Severe Maternal Morbidity Indicators and Corresponding ICD-10-CM Codes During

Delivery and Postpartum Hospitalizations

Severe Maternal Morbidity

Diagnosis (DX) or

Indicator

Procedure (PR)

ICD-10-CM

Acute myocardial infarction

DX

I21.xx, I22.x

Aneurysm

DX

I71.xx, I79.0

Acute renal failure

DX

N17.x, O90.4

Adult respiratory distress

DX

J80, J95.1, J95.2, J95.3, J95.82x, J96.0x,

syndrome

J96.2x R09.2

Amniotic fluid embolism

DX

O88.1x

Cardiac arrest/ventricular

DX

I46.x, I49.0x

fibrillation

Conversion of cardiac rhythm

PR

5A2204Z, 5A12012

Disseminated intravascular

DX

D65, D68.8, D68.9, O72.3

coagulation

Eclampsia

DX

O15.x

Heart failure or arrest during

DX

I97.12x, I97.13x, I97.710, I97.711

surgery or procedure

Puerperal cerebrovascular

DX

I60.xx-I68.xx, O22.51, O22.52, O22.53,

disorders

I97.81x, I97.82x, O87.3

Pulmonary edema / acute heart

DX

J81.0, I50.1, I50.20, I50.21, I50.23, I50.30,

failure

I50.31, I50.33, I50.40, I50.41, I50.43, I50.9

Severe anesthesia complications

DX

O74.0 , O74.1 , O74.2, O74.3, O89.0x,

O89.1, O89.2

Sepsis

DX

O85, O86.04, T80.211A, T81.4XXA,

T81.44xx, R65.20, A40.x, A41.x, A32.7

Shock

DX

O75.1, R57.x, R65.21, T78.2XXA, T88.2 XXA,

T88.6 XXA, T81.10XA , T81.11XA, T81.19XA

Sickle cell disease with crisis

DX

D57.0x, D57.21x, D57.41x, D57.81x

Air and thrombotic embolism

DX

I26.x, O88.0x, O88.2x, O88.3x, O88.8x

Blood transfusion

PR

30233, 30240, 30243a

Hysterectomy

PR

0UT90ZZ, 0UT94ZZ, 0UT97ZZ, 0UT98ZZ,

0UT9FZZ, 0UT90ZL

Temporary tracheostomy

PR

0B110Z, 0B110F, 0B113, 0B114

Ventilation

PR

5A1935Z, 5A1945Z, 5A1955Z

a

Simplified for table purposes ¨C includes 160 codes.

Modified from Centers for Disease Control and Prevention. How does CDC identify severe maternal

morbidity? Available at: . Retrieved March 6, 2020.

Leonard SA, Kennedy CJ, Carmichael SL, Lyell DJ, Main EK. An expanded obstetric comorbidity scoring system for

predicting severe maternal morbidity. Obstet Gynecol 2020;136.

The authors provided this information as a supplement to their article.

?2020 American College of Obstetricians and Gynecologists.

Page 1 of 14

Appendix 2. Comorbidities and Corresponding ICD-10-CM Diagnosis Codes Compared With Prior

Obstetric Comorbidity Indices

Potential Comorbidity

Diagnosis Group

Leonard, et al, 2020

ICD-10-CM Codes

Bateman, et al. 2013

ICD-9-CM Codes

Consistent Comorbidities (Codes only updated to ICD-10-CM)

Gestational diabetes

O24.4

648.8x (without

mellitus

preexisting diabetes)

HIV/AIDS

O98.7, B20

042.x, V08.x

Preexisting diabetes

E08-E13, O24.0, O24.1,

250.x, 648.0x

mellitus

O24.3, O24.8, O24.9,

Z79.4

Previous cesarean birth

O34.21

654.2x

Pulmonary hypertension

I27.0, I27.2

416.0x, 416.8x, 416.9x

Twin/multiple pregnancy

O30, O31, Z37.2-Z37.7

V27.2-V27.8, 651.x

Easter, et al. 2019a

Clinical diagnoses

only

(no ICD codes)

Included (Only with

insulin therapy)

Included

Diabetes with insulin

therapy

Included

Included

Included

Modified Comorbidities (additional codes added to or removed from existing diagnosis groups or

changed groupings)

Asthma, acute or

O99.5, J45.21, J45.22,

493.x

Included

moderate/severe

J45.31, J45.32, J45.4,

(all asthma codes)

(all asthma codes)

J45.5, J45.901, J45.902

(limited to moderate or

severe asthma)

Bleeding disorder,

D66-D69

282.4x, 282.6x (sickle

Included

preexisting

(added bleeding

cell disease only &

(also included

disorders--but not DIC

includes sickle cell with

anticoagulation)

or sickle cell with crisis)

crisis)

BMI at delivery

Z68.4 (categorized as

278.0x, 649.1x, V85.3,

Included

¡Ý40)

V85.4 (obesity)

(categorized as >40

and >50)

Cardiac disease,

I05-I09, I11-I13, I15,

745.0x-747.4x, 648.5x;

Included (separated

preexisting

I16, I20, I25, I27.8, I30412.x-414.x; 428.22,

types of cardiac

I41, I44-I49, I50.22,

428.23, 428.32, 428.33,

disease)

I50.23, I50.32, I50.33,

428.42, 428.43,

I50.42, I50.43, I50.812,

394.x-397.x, 424.x

I50.813 O99.41,

(separated types of

O99.42, Q20-Q24

cardiac disease)

(broader set of codes)

Chronic hypertension

O10, O11, I10

401.x-405.x, 642.0xIncluded (gestational

642.2x, 642.7x

and chronic

Leonard SA, Kennedy CJ, Carmichael SL, Lyell DJ, Main EK. An expanded obstetric comorbidity scoring system for

predicting severe maternal morbidity. Obstet Gynecol 2020;136.

The authors provided this information as a supplement to their article.

?2020 American College of Obstetricians and Gynecologists.

Page 2 of 14

Chronic renal disease

Connective tissue or

autoimmune disease

Placenta previa, complete

or partial

Preeclampsia with severe

features

Preeclampsia without

severe features or

gestational hypertension

O26.83, I12, I13, N03N05, N07, N08, N11.1,

N11.8, N11.9, N18,

N25.0, N25.1, N25.81,

N25.89, N25.9, N26.9

(broader set of codes)

M30-M36 (broad range

of diseases that

includes systemic lupus

erythematosus)

O44.03, O44.13,

O44.23, O44.33

581.x-583.x, 585.x, 587.x,

588.x, 646.2x

O14.1, O14.2, O11

(excludes eclampsia as

eclampsia is included in

SMM)

O13, O14.0, O14.9

642.5x, 642.6x (includes

eclampsia)

Substance use disorder

F10-F19, O99.31,

O99.32

(much broader set of

codes)

Maternal age

Birth certificate

(categorized as ¡Ý35)

Added Comorbidities

Anemia, preexisting

O99.01, O99.02, D50,

D55, D56, D57.1,

D57.20, D57.3, D57.40,

D57.80, D55, D56, D58,

D59 (limited to codes

hypertension

grouped together)

Included

710.0x (only systemic

lupus erythematosus)

Autoimmune disease

or systemic lupus

erythematosus

641.0x, 641.1x (not

limited to third

trimester/delivery)

Included

(grouped with

accreta and

abruption)

Included

(includes eclampsia)

642.3x, 642.4x, 642.7x

(without severe

preeclampsia or

eclampsia; separated

mild/unspecified

preeclampsia and

gestational hypertension)

304.x, 305.2x-305.9x,

648.3x, 291.xx, 303.xx,

305.0x, 305.1x, 649.0x

(separated into drug use,

alcohol abuse, and

tobacco use)

Admin Data

(categorized as 35-39,

40-44, ¡Ý45)

Not used

Included

Included (separated

as substance use

disorder and alcohol

abuse)

Included

(categorized as 3539, 40-44, ¡Ý45)

Not used

Leonard SA, Kennedy CJ, Carmichael SL, Lyell DJ, Main EK. An expanded obstetric comorbidity scoring system for

predicting severe maternal morbidity. Obstet Gynecol 2020;136.

The authors provided this information as a supplement to their article.

?2020 American College of Obstetricians and Gynecologists.

Page 3 of 14

that are likely present

on delivery admission)

O99.84

K (entire block), O99.6,

O26.6

O99.34, F20-F39

Not used

Not used

Not used

Not used

Not used

Not used

O99.35, G40, G70

O45

Not used

Not used

O43.2

Not used

(no adequate ICD-9

codes)

Preterm birth

Z3A.20-Z3A.36 ( ................
................

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