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 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
I62.9 – 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.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.