High Priority MeasureNo
Percentage of pregnant female patients aged 14 to 50 who present to the emergency department (ED) with a chief complaint of abdominal pain or vaginal bleeding who receive a trans-abdominal or trans-vaginal ultrasound to determine pregnancy location
This measure is to be submitted each time a patient who presents in the emergency department with a chief complaint of abdominal pain and/or vaginal bleeding who receive a trans-abdominal or trans-vaginal ultrasound during the performance period. It is anticipated that eligible clinicians who provide care in the emergency department will submit this measure. The Part B claim form place of service field must indicate that the encounter has taken place in the emergency department.
The listed denominator criteria is used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions allowed by the measure. The quality-data codes listed do not need to be submitted for registry-based submissions; however, these codes may be submitted for those registries that utilize claims data.
All pregnant female patients aged 14 to 50 who present to the ED with a chief complaint of abdominal pain or vaginal bleeding
Denominator Criteria (Eligible Cases):
Pregnant females aged 14 to 50
Diagnosis of Other Current Condition in the Mother Classifiable Elsewhere but Complicating Pregnancy, Childbirth, or the Puerperium (ICD-10-CM): O26.891, O26.899, O26.90, O26.91
Diagnosis of Abdominal Pain (ICD-10-CM): R10.0, R10.10, R10.13, R10.2, R10.30, R10.31, R10.32, R10.33, R10.813, R10.814, R10.815, R10.816, R10.817, R10.819, R10.823, R10.824, R10.825, R10.826, R10.827, R10.829, R10.84, R10.9
Diagnosis of Vaginal Bleeding (ICD-10-CM): O20.0, O20.8, O20.9, O44.30, O44.50, O44.31, O44.51, O45.001, O45.009, O45.011, O45.019, O45.021, O45.029, O45.091, O45.099, O45.8X1, O45.8X9, O45.90, O45.91, O46.001, O46.009, O46.011, O46.019, O46.021, O46.029, O46.091, O46.8X1, O46.8X9, O46.90, O46.91, O46.099
Patient encounter during the performance period (CPT): 99281, 99282, 99283, 99284, 99285, 99291
Place of Service Indicator: 23
(The Part B claim form Place of Service field must indicate emergency department)
Patients who receive a trans-abdominal or trans-vaginal ultrasound with documentation of pregnancy location in medical record
Numerator Instructions: This measure is to be submitted each time a patient meets the requirements as indicated in the denominator. If the clinician documents that the clinical event surrounding the patient, with or without performance of trans-abdominal or trans-vaginal ultrasound, does not meet the intent of the measure, submit quality-data code G8807.
Performance Met: Performance of trans-abdominal or trans-vaginal ultrasound (G8806)
Denominator Exception: Trans-abdominal or trans-vaginal ultrasound not performed for reasons documented by clinician (e.g., patient has visited the ED multiple times within 72 hours, patient has a documented Intrauterine Pregnancy [IUP]) (G8807)
Performance Not Met: Trans-abdominal or trans-vaginal ultrasound not performed, reason not given (G8808)