How Does CDC Identify Severe Maternal Morbidity?
To identify delivery hospitalizations with SMM, CDC uses administrative hospital discharge data and International Classification of Diseases (ICD) diagnosis and procedure codes. The original list of 25 SMM indicators based on the 9th Revision of ICD was published in 2012.2 In October 2015, the United States transitioned to the 10th Revision of ICD to code diagnoses and procedures. CDC, along with our clinical and public health partners, took the opportunity to review this new version of ICD coding to update the indicators, taking into account results from validation studies. The updated list of 21 indicators and corresponding ICD codes used to identify delivery hospitalizations with SMM for both ICD-9 and ICD-10 can be used to track SMM when using administrative hospital discharge data from October 2015 and beyond.
Severe Morbidity Indicators and Corresponding ICD-9-CM/ICD-10-CM/PCS Codes During Delivery Hospitalizations
The table below includes the list of 21 indicators and corresponding ICD codes used to identify delivery hospitalizations with SMM.
| Severe Maternal Morbidity Indicator | Diagnosis (DX) or Procedure (PR) Code | ICD-9 | ICD-10 |
|---|---|---|---|
| Acute Myocardial Infarction | DX | 410.xx | I21.xx, I22.x |
| Aneurysm | DX | 441.xx | I71.xx, I79.0 |
| Acute Renal Failure | DX | 584.5, 584.6, 584.7, 584.8, 584.9, 669.3x | N17.x, O90.4 |
| Acute Respiratory Distress Syndrome | DX | 518.5x, 518.81, 518.82, 518.84, 799.1 | J80, J95.1, J95.2, J95.3, J95.82x, J96.0x, J96.2x, J96.9x, R06.03, R09.2 |
| Amniotic Fluid Embolism | DX | 673.1x | O88.112, O88.113, O88.119, O88.12, O88.13 |
| Cardiac Arrest / Ventricular Fibrillation | DX | 427.41, 427.42, 427.5 | I46.x, I49.0x |
| Conversion of Cardiac Rhythm | PR | 99.6x | 5A12012, 5A2204Z |
| Disseminated Intravascular Coagulation | DX | 286.6, 286.9, 641.3x, 666.3x | D65, D68.8, D68.9, O45.002, O45.003, O45.009, O45.012, O45.013, O45.019, O45.022, O45.023, O45.029, O45.092, O45.093, O45.099, O46.002, O46.003, O46.009, O46.012, O46.013, O46.019, O46.022, O46.023, O46.029, O46.092, O46.093, O46.099, O67.0, O72.3 |
| Blood Transfusion* | PR | 99.0x | 30230H0, 30230K0, 30230L0, 30230M0, 30230N0, 30230P0, 30230R0, 30230T0, 30230H1, 30230K1, 30230L1, 30230M1, 30230N1, 30230P1, 30230R1, 30230T1, 30233H0, 30233K0, 30233L0, 30233M0, 30233N0, 30233P0, 30233R0, 30233T0, 30233H1, 30233K1, 30233L1, 30233M1, 30233N1, 30233P1, 30233R1, 30233T1, 30240H0, 30240K0, 30240L0, 30240M0, 30240N0, 30240P0, 30240R0, 30240T0, 30240H1, 30240K1, 30240L1, 30240M1, 30240N1, 30240P1, 30240R1, 30240T1, 30243H0, 30243K0, 30243L0, 30243M0, 30243N0, 30243P0, 30243R0, 30243T0, 30243H1, 30243K1, 30243L1, 30243M1, 30243N1, 30243P1, 30243R1, 30243T1 |
| Eclampsia | DX | 642.6x | O15. X |
| Heart Failure / Arrest During Surgery or Procedure | DX | 997.1 | I97.120, I97.121, I97.130, I97.131, I97.710, I97.711 |
| Puerperal Cerebrovascular Disorders | DX | 046.3, 348.39, 362.34, 430.xx, 431.xx, 432.xx, 433.xx, 434.xx, 435.xx, 436.xx, 437.xx, 671.5x, 674.0x, 997.02 | A81.2, G45.x, G46.x, G93.49, H34.0x, I60.xx, I61.xx, I62.xx, I63.00, I63.01x, I63.1xx, I63.2xx, I63.3xx, I63.4xx, I63.5xx, I63.6, I63.8x, I63.9, I65.xx, I66.xx, I67.xx, I68.xx, O22.50, O22.52, O22.53, I97.810, I97.811, I97.820, I97.821, O87.3 |
| Pulmonary Edema / Acute Heart Failure | DX | 428.0, 428.1, 428.20, 428.21, 428.23, 428.30, 428.31, 428.33, 428.40, 428.41, 428.43, 428.9, 518.4 | I50.1, I50.20, I50.21, I50.23, I50.30, I50.31, I50.33, I50.40, I50.41, I50.43, I50.810, I50.811, I50.813, I50.814, I50.82, I50.83, I50.84, I50.89, I50.9, J81.0 |
| Severe Anesthesia Complications | DX | 668.0x, 668.1x, 668.2x, 995.4, 995.86 | O29.112-O29.119, O29.122-O29.129, O29.192-O29.199, O29.212-O29.219, O29.292-O29.299, O74.0, O74.1, O74.2, O74.3, O89.0x, O89.1, O89.2, T88.2XXA, T88.3XXA |
| Sepsis | DX | 038.xx, 449, 785.52, 995.91, 995.92, 998.02, 670.2x (after October 1, 2009) | A32.7, A40.x, A41.x, I76, O85, O86.04, R65.20, R65.21, T81.12XA, T81.44XA |
| Shock | DX | 669.1x, 785.50, 785.51, 785.59, 995.0, 998.0*, 998.00, 998.01, 998.09 *998.0 is not a valid code but was used prior to 2012 |
O75.1, R57.x, T78.2XXA, T81.10XA, T81.11XA, T81.19XA, T88.6XXA |
| Sickle Cell Disease with Crisis | DX | 282.42, 282.62, 282.64, 282.69, 289.52 | D57.00, D57.01, D57.02, D57.211, D57.212, D57.219, D57.411, D57.412, D57.419, D57.811, D57.812, D57.819 |
| Air and Thrombotic Embolism | DX | 415.0, 415.1x, 673.0x, 673.2x, 673.3x, 673.8x | I26.x, O88.012-O88.03, O88.212-O88.23, O88.312-O88.33, O88.812-O88.83, T80.0XXA |
| Hysterectomy | PR | 68.39, 68.49, 68.59, 68.69, 68.79, 68.9 (also include 68.3, 68.4, 68.5, 68.6, 68.7; non-specific codes used frequently) | 0UT90ZL, 0UT90ZZ, 0UT97ZL, 0UT97ZZ |
| Temporary Tracheostomy | PR | 31.1 | 0B110F4, 0B113F4, 0B114F4 |
| Ventilation | PR | 96.70, 96.71, 96.72 | 5A1935Z, 5A1945Z, 5A1955Z |
*Excluded, but could be examined separately.
1. Applicable to delivery hospitalizations for patients aged 12 – 55 years inclusive.
2. Use a code under Z3A (Z3A.20-Z3A.42) to document the exact week during the pregnancy.