Performance Measurement Network

Question: Why aren't more exclusions to elective delivery considered?

Exclusion Table 11.07 in Appendix A does not include codes for some of the ACOG accepted reasons to deliver newborns prior to 39 weeks gestation. Can you provide us with an explanation please?


The purpose of this measure is to enable hospitals to establish a baseline for their performance, which in turn serves as a determinant of whether improvement efforts are effective over time. The ACOG justifications are indeed acceptable reasons for an elective delivery; however, as an example there is no ICD-9-CM code for a "previous" classical cesarean section, only a "current" classical cesarean section (74.0). In order to include this exclusion in the measure, a data element would need to be created and every chart would need to be manually reviewed to determine if this was present in the medical record. A classical cesarean section is typically a rather infrequent procedure. The issue with regard to additional exclusions from the denominator for this measure really has to do with the burden of data collection versus the frequency with which these conditions occur. We are always very mindful of the amount of resources required to collect data for our measures, and it was felt by our Technical Advisory Panel that the value of including every conceivable justification for an elective delivery (even if they could all be identified, which seems unlikely) would be far outweighed by the additional time required to identify those cases via medical record review. This is especially true in the case of conditions for which there is no existing ICD-9-CM code.

Question Details
Focus area(s): Chart Abstracted Measure Specifications – Clinical
Related documents: PC, Elective deliveries, Appendix: Code tables

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