Measure Description
Percentage of Rh-negative pregnant women aged 14-50 years at risk of fetal blood exposure who receive Rh- Immunoglobulin (Rhogam) in the emergency department (ED)
Instructions
This measure is to be submitted each time a pregnant patient presents to the ED with complaints including blunt abdominal trauma, vaginal bleeding, ectopic pregnancy, and threatened or spontaneous abortion.
The Merit-based Incentive Payment System (MIPS) eligible clinician, group, or third party intermediary may utilize claims data to determine the ED discharge. Patients who present to the ED with these complaints should have documentation in the medical record of receiving an order for Rh-Immunoglobulin (Rhogam). It is anticipated that MIPS eligible clinicians who provide care in the ED will submit this measure. For MIPS eligible clinicians, groups, or third party intermediaries using claims data, the claim form place of service field must indicate that the encounter has taken place in the ED.
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 pregnant female patients aged 14 to 50 years who are Rh-negative and at significant risk of fetal blood exposure
Denominator Criteria (Eligible Cases):
Pregnant female patients aged 14 to 50 years on date of encounter
AND
Diagnosis of 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, O44.31, O44.50, 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 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 quality-data 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)