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 2012.8 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.

Appendix 2. 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 Indicators and Corresponding ICD Codes during
Severe Maternal Morbidity Indicator DX or PR ICD-9 ICD-10 ICD-10 short
1. Acute myocardial infarction DX 410.xx I21.01, I21.02, I21.09, I21.11, I21.19, I21.21, I21.29, I21.3, I21.4, I21.9, I21.A1 and I21.A9

 

I22.0, I22.1, I22.2, I22.8, I22.9

I21.xx, I22.x
2. Aneurysm* DX 441.xx I71.00 – I71.03, I71.1, I71.2, I71.3, I71.4, I71.5, I71.6, I71.8, I71.9, I79.0 I71.xx*

I79.0*No I71.7 code exists, so ICD-10 list encompasses all possible I71 codes

3. Acute renal failure DX 584.5, 584.6, 584.7, 584.8, 584.9, 669.3x N17.0, N17.1, N17.2, N17.8, N17.9, O90.4 N17.x, O90.4
4. Adult respiratory distress syndrome DX 518.5x, 518.81 518.82 518.84, 799.1 J80, J95.1, J95.2, J95.3, J95.821, J95.822, J96.00, J96.01, J96.02,
J96.20, J96.21, J96.22, R09.2
J80, J95.1, J95.2, J95.3, J95.82x, J96.0x, J96.2x R09.2
5. Amniotic fluid embolism DX 673.1x O88.11x*, O88.12 (childbirth), O88.13 (puerperium)

* x=1st, 2nd and 3rd trimester

O88.1x
6. Cardiac arrest/ventricular fibrillation* DX 427.41, 427.42*, 427.5

* Ventricular flutter

I46.2, I46.8, I46.9, I49.01*, I49.02**

* Ventricular fibrilation

** Ventricular flutter

I46.x, I49.0x
7. Conversion of cardiac rhythm PR 99.6x 5A2204Z, 5A12012 5A2204Z, 5A12012
8. Disseminated intravascular coagulation DX 286.6, 286.9, 666.3x D65, D68.8, D68.9, O72.3*

*see comments for pregnancy related codes

D65, D68.8, D68.9, O72.3
9. Eclampsia DX 642.6x O15.00, O15.02, O15.03, O15.1, O15.2, O15.9

 

 

O14.22 – HELLP syndrome (HELLP), second trimester, O14.23 – HELLP syndrome (HELLP), third trimester

HELLP syndrome is not included currently (ranges in severity, more research is needed)

O15. X
10. Heart failure/arrest during surgery or procedure DX 997.1 I97.120, I97.121, I97.130, I97.131, I97.710, I97.711 I97.12x, I97.13x, I97.710, I97.711
11. Puerperal cerebrovascular disorders DX 430.xx, 431.xx, 432.xx, 433.xx, 434.xx, 436xx, 437.xx, 671.5x, 674.0x, 997.02 I60.0x, I60.1x, I60.2, I60.3x, I60.4, I60.5x, I60.6, I60.7, I60.8, I60.9;
I61.1, I61.2, I61.3, I61.4, I61.5, I61.6, I61.8, I61.9;
I62.0x, I62.1, I62.9;I63.0xx, I63.1xx, I63.2xx, I63.3xx, I63.4xx , I63.5xx, I63.6, I63.8, I63.9;
I65.0x, I65.1, I65.2x, I65.8, I65.9;
I66.0x, I66.1x, I66.2x, I66.3, I66.8, I66.9;
I67.0, I67.1, I67.2, I67.3, I67.4, I67.5, I67.6, I67.7, I67.8xx, I67.9;
I68.0, I68.2, I68.8;
O22.51, O22.52, O22.53,
I97.810, I97.811, I97.820, I97.821, O87.3
674.0x – no crosswalk
I60.xx- I68.xx, O22.51, O22.52, O22.53, I97.81x, I97.82x, O87.3

 

168.9 – included but should not be captured if this is not a valid code.

 

 

12. Pulmonary edema / Acute heart failure DX 518.4, 428.1, 428.0, 428.21, 428.23, 428.31, 428.33, 428.41, 428.43 J81.0, I50.1, I50.20, I50.21, I50.23, I50.30, I50.31, I50.33, I50.40, I50.41, I50.43, I50.9

(-) Add 5th character: 0=unspecified 1=acute 2=chronic 3=acute on chronic

0=unspecified – keep since it is commonly used among health care providers terminology in medical records

J81.0, I50.1, I50.20, I50.21, I50.23, I50.30, I50.31, I50.33, I50.40, I50.41, I50.43, I50.9

 

13. Severe anesthesia complications DX 668.0x*, 668.1x, 668.2x O74.0 , O74.1, O74.2, O74.3,

O89.01*, O89.09, O89.1, O89.2

*O89.01 Aspiration – decided to keep due to difficulties of separation from “Aspiration Pnuemonitis”

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

 

 

14. Sepsis DX 038.xx, 995.91, 995.92, 670.2x (after October 1, 2009) O85, O86.04, T80.211A, T81.4XXA, T81.44, T81.44XA, T81.44XD, T81.44XS

or

severity: R65.20

or A40.0, A40.1 , A40.3 , A40.8, A40.9, A41.01, A41.02, A41.1, A41.2, A41.3, A41.4, A41.50, A41.51, A41.52, A41.53, A41.59, A41.81, A41.89, A41.9, A32.7

 

O85, O86.04, T80.211A, T81.4XXA, T81.44xx,

or

R65.20

or A40.x, A41.x, A32.7

 

15. Shock DX 669.1x, 785.5x, 995.0, 995.4, 998.0x O75.1, R57.0, R57.1, R57.8, R57.9, R65.21, T78.2XXA, T88.2XXA , T88.6XXA, T81.10XA, T81.11XA, T81.19XA O75.1, R57.x, R65.21, T78.2XXA, T88.2 XXA, T88.6 XXA, T81.10XA , T81.11XA, T81.19XA
16. Sickle cell disease with crisis DX 282.42, 282.62, 282.64, 282.69 D57.00 , D57.01, D57.02, D57.211, D57.212, D57.219, D57.411, D57.412, D57.419, D57.811, D57.812, D57.819

(5th digit: unspecified, acute chest syndrome or splenic sequestration)

D57.0x, D57.21x, D57.41x, D57.81x
17. Air and thrombotic embolism DX 415.1x, 673.0x, 673.2x

673.3x, 673.8x

I26.01, I26.02, I26.09, I26.90, I26.92, I26.99

O88.011-O88.019, 088.02, O88.03, O88.211-O88.219, O88.22, O88.23, O88.311-O88.319, O88.32, O88.33, O88.81, O88.82, O88.83
* I26.0 – Pulmonary embolism with acute cor pulmonaleexternal icon (acute right ventricle heart failure)

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

 

 

18. Blood products transfusion PR 99.0x 99.0x à 160 ICD-10-PCS codes

The most common

30233H1 Transfusion of Nonautologous Whole Blood into Peripheral Vein, Percutaneous Approach

30233K1 Transfusion of Nonautologous Frozen Plasma into Peripheral Vein, Percutaneous Approach

30233L1 Transfusion of Nonautologous Fresh Plasma into Peripheral Vein, Percutaneous Approach

30233M1 Transfusion of Nonautologous Plasma Cryoprecipitate into Peripheral Vein, Percutaneous Approach

30233N1 Transfusion of Nonautologous Red Blood Cells into Peripheral Vein, Percutaneous Approach

30233P1 Transfusion of Nonautologous Frozen Red Cells into Peripheral Vein, Percutaneous Approach

30233R1 Transfusion of Nonautologous Platelets into Peripheral Vein, Percutaneous Approach

30233T1 Transfusion of Nonautologous Fibrinogen into Peripheral Vein, Percutaneous Approach

30240H1 Transfusion of Nonautologous Whole Blood into Central vein, open approach

30240K1 Transfusion of Nonautologous Frozen Plasma into Central vein, open approach

30240L1 Transfusion of Nonautologous Fresh Plasma into Central vein, open approach

30240M1 Transfusion of Nonautologous Plasma Cryoprecipitate into Central vein, open approach

30240N1 Transfusion of Nonautologous Red Blood Cells into Central vein, open approach

30240P1 Transfusion of Nonautologous Frozen Red Cells into Central vein, open approach

30240R1 Transfusion of Nonautologous Platelets into Central vein, open approach

30240T1 Transfusion of Nonautologous Fibrinogen into Central vein, open approach

30243H1 Transfusion of Nonautologous Whole Blood into Central vein, percutaneous approach

30243K1 Transfusion of Nonautologous Frozen Plasma into Central vein, percutaneous approach

30243L1 Transfusion of Nonautologous Fresh Plasma into Central vein, percutaneous approach

30243M1 Transfusion of Nonautologous Plasma Cryoprecipitate into Central vein, percutaneous approach

30243N1 Transfusion of Nonautologous Red Blood Cells into Central vein, percutaneous approach

30243P1 Transfusion of Nonautologous Frozen Red Cells into Central vein, percutaneous approach

30243R1 Transfusion of Nonautologous Platelets into Central vein, percutaneous approach

30243T1 Transfusion of Nonautologous Fibrinogen into Central vein, percutaneous approach

30233N0 Transfusion of Autologous Red Blood Cells into Peripheral Vein, Percutaneous Approach

30233P0 Transfusion of Autologous Frozen Red Cells into Peripheral Vein, Percutaneous Approach

30240N0 Transfusion of Autologous Red Blood Cells into Central vein, open approach

30240P0 Transfusion of Autologous Frozen Red Cells into Central vein, open approach

30243N0 Transfusion of Autologous Red Blood Cells into Central vein, percutaneous approach

30243P0 Transfusion of Autologous Frozen Red Cells into Central vein, percutaneous approach

 

30233 Peripheral vein, percutaneous

(7th digit: x=1: nonautologous)

30240 Central Vein, open

(7th digit: x=1: nonautologous)

30243 Central Vein, percutaneous

(7th digit: x=1: nonautologous

x=0: autologous)

+

Hx (whole blood)

Kx (frozen plasma)

Lx (fresh Plasma)

Mx (plasma cryoprecipitate)

Nx (red blood cells)

Px (frozen Red cells)

Rx (platelets)

Tx (fibrinogen)

Blood

Complete list of blood product transfusion codes:

 

‘30233H1′,’30233L1’, ‘30233K1’, ‘30233M1’, ‘30233N1′,’30233P1′,’30233R1′,’30233T1’,

‘30233H0′,’30233L0’, ‘30233K0’, ‘30233M0’, ‘30233N0′,’30233P0′,’30233R0′,’30233T0’,

‘30230H1′,’30230L1’, ‘30230K1’, ‘30230M1’, ‘30230N1′,’30230P1′,’30230R1′,’30230T1’,

‘30230H0′,’30230L0’, ‘30230K0’, ‘30230M0’, ‘30230N0′,’30230P0′,’30230R0′,’30230T0’,

‘30240H1′,’30240L1’, ‘30240K1’, ‘30240M1’, ‘30240N1′,’30240P1′,’30240R1′,’30240T1’,

‘30240H0′,’30240L0’, ‘30240K0’, ‘30240M0’, ‘30240N0′,’30240P0′,’30240R0′,’30240T0’,

‘30243H1′,’30243L1’, ‘30243K1’, ‘30243M1’, ‘30243N1′,’30243P1′,’30243R1′,’30243T1’,

‘30243H0′,’30243L0’, ‘30243K0’, ‘30243M0’, ‘30243N0′,’30243P0′,’30243R0′,’30243T0’,

‘30250H1′,’30250L1’, ‘30250K1’, ‘30250M1’, ‘30250N1′,’30250P1′,’30250R1′,’30250T1’,

‘30250H0′,’30250L0’, ‘30250K0’, ‘30250M0’, ‘30250N0′,’30250P0′,’30250R0′,’30250T0’,

‘30253H1′,’30253L1’, ‘30253K1’, ‘30253M1’, ‘30253N1′,’30253P1′,’30253R1′,’30253T1’,

‘30253H0′,’30253L0’, ‘30253K0’, ‘30253M0’, ‘30253N0′,’30253P0′,’30253R0′,’30253T0’,

‘30260H1′,’30260L1’, ‘30260K1’, ‘30260M1’, ‘30260N1′,’30260P1′,’30260R1′,’30260T1’,

‘30260H0′,’30260L0’, ‘30260K0’, ‘30260M0’, ‘30260N0′,’30260P0′,’30260R0′,’30260T0’,

‘30263H1′,’30263L1’, ‘30263K1’, ‘30263M1’, ‘30263N1′,’30263P1′,’30263R1′,’30263T1’,

‘30263H0′,’30263L0’, ‘30263K0’, ‘30263M0’, ‘30263N0′,’30263P0′,’30263R0′,’30263T0’

19. Hysterectomy PR 68.3x-68.9x 0UT90ZZ, 0UT94ZZ, 0UT97ZZ, 0UT98ZZ, 0UT9FZZ 0UT90ZZ, 0UT94ZZ, 0UT97ZZ, 0UT98ZZ, 0UT9FZZ
20. Temporary tracheostomy* PR 31.1 0B110Z4, 0B110F4, 0B113Z4, 0B113F4, 0B114Z4, 0B114F4 0B110Z, 0B110F, 0B113, 0B114
21.Ventilation PR 93.90, 96.01, 96.02, 96.03, 96.05 5A1935Z, 5A1945Z,

5A1955Z

5A1935Z, 5A1945Z,

5A1955Z

For all pregnancy related codes O00-O9A:

1. are only applicable to maternity patients aged 12 – 55 years inclusive

2. Use a code under Z3A (Z3A.20-Z3A.42) to document the exact week during the pregnancy

3. *Due to rare prevalences, the following indicators may be combined for reporting purposes: 1) Acute myocardial infarction and aneurysm; 2) cardiac arrest/ventricular fibrillation and conversion of cardiac rhythm; and 3) temporary tracheostomy and ventilation.