#255: Rh Immunoglobulin (Rhogam) for Rh-Negative Pregnant Women at Risk of Fetal Blood Exposure

Quality ID

255

High Priority Measure

No

Specifications

Registry

Measure Type

Process

Specialty

Emergency Medicine

Measure description

Percentage of Rh-negative pregnant women aged 14-50 years at risk of fetal blood exposure who receive RhImmunoglobulin (Rhogam) in the emergency department (ED)

 

Instructions

This measure is to be submitted each time a pregnant patient presents to the emergency department with complaints including blunt abdominal trauma, vaginal bleeding, ectopic pregnancy, and threatened or spontaneous abortion. Registries may utilize claims data to determine the emergency department discharge. Patients who present to the emergency department with these complaints should have documentation in the medical record of receiving an order for Rh-Immunoglobulin (Rhogam). It is anticipated that eligible clinicians who provide care in the emergency department will submit this measure. For registries using claims data, the Part B claim form place of service field must indicate that the encounter has taken place in the emergency department.

Measure Submission:

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.

 

Denominator

All pregnant female patients aged 14 to 50 years who are Rh-negative and at significant risk of fetal blood exposure

Denominator Criteria (Eligible Cases):

Female patients aged 14 to 50 years on date of encounter

AND

Diagnosis for Rh-Negative (ICD-10-CM): O36.0110, O36.0111, O36.0190, O36.0191, O36.0910, O36.0911, O36.0990, O36.0991

AND

Diagnosis of High Risk Pregnancy Complications (ICD-10-CM): O00.80, O00.81, O00.90, O00.91, O02.1, O03.1, O03.6, O04.6, O07.1, O08.1, O20.0, O20.8, O20.9, O26.891, O43.011, O43.019, 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, O46.011, O46.021, O46.8X1, O46.8X9, O46.90, O46.91

AND

Patient encounter during the performance period (CPT): 99281, 99282, 99283, 99284, 99285, 99291

AND

Place of Service Indicator: 23

(The Part B claim form Place of Service field must indicate emergency department)

 

Numerator

Patients who receive an order for Rh-Immunoglobulin (Rhogam) in the ED

Numerator Instructions: This measure is to be submitted each time a patient meets the requirements as indicated in the denominator. In the clinical event a patient has documented receipt of Rhogam submit qualitydata code G8810.

Numerator Options:

Performance Met: Rh-immunoglobulin (Rhogam) ordered (G8809)

OR

Denominator Exception: Rh-immunoglobulin (Rhogam) not ordered for reasons documented by clinician (e.g., patient had prior documented receipt of Rhogam within 12 weeks, patient refusal) (G8810)

OR

Performance Not Met: Documentation Rh-immunoglobulin (Rhogam) was not ordered, reason not given (G8811)

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