2021 MIPS Measure #335: Maternity Care: Elective Delivery or Early Induction Without Medical Indication at < 39 Weeks (Overuse)

Measure Description

Percentage of patients, regardless of age, who gave birth during a 12-month period who delivered a live singleton at < 39 weeks of gestation completed who had elective deliveries by cesarean section (C-section), or early inductions of labor, without medical indication.

Instructions

This measure is to be submitted each time a procedure is performed for patients undergoing delivery by C-section, or induction of labor, at less than 39 weeks gestation during the performance period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

Measure Submission Type:

Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

Denominator

All patients, regardless of age, who gave birth during a 12-month period delivering a live singleton at < 39 weeks of gestation completed

Denominator Criteria (Eligible Cases):

All patients, regardless of age

AND

Live Singleton (ICD-10-CM): Z37.0

AND

Patient procedure during performance period (CPT): 59400, 59409, 59410, 59510, 59514, 59515, 59610, 59612, 59614, 59618, 59620, 59622

AND

Delivery at < 39 weeks gestation

Numerator

Patients who had elective deliveries by C-section, or early inductions of labor, without medical indication

Numerator Options:

Performance Met:

Early elective delivery by C-section, or early elective induction, not performed (< 39 weeks gestation) (G9355)

OR

Denominator Exception:

Medical indication for induction [Documentation of reason(s) for elective delivery (C-section) or early Induction) (e.g., hemorrhage and placental complications, hypertension, preeclampsia and eclampsia, rupture of membranes (premature or prolonged), maternal conditions complicating pregnancy/delivery, fetal conditions complicating pregnancy/delivery, late pregnancy, prior uterine surgery, or participation in clinical trial)] (G9361)

OR

Performance Not Met:

Early elective delivery by C-section, or early elective induction, performed (< 39 weeks gestation) (G9356)