Measure Description
Percentage of pregnant or postpartum patients who received a cardiovascular disease (CVD) risk assessment with a standardized instrument.
Instructions
This measure is to be submitted a minimum of once per performance period for all patients seen for pregnancy or postpartum care during the performance period. This measure is intended to reflect the quality of services provided for pregnant and postpartum patients. 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.
NOTE: The aim of this measure is that 100 percent of eligible pregnant/postpartum patients undergo CVD risk assessment using a standardized tool. Every patient should be assessed for CVD risk at least once and as needed, additional times if symptoms present during the pregnancy postpartum period.
NOTE: Patient encounters for this measure conducted via telehealth (including but not limited to encounters coded with GQ, GT, 95, POS 02, POS 10) are allowable.
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
Patients who have an office visit for prenatal or postpartum care, regardless of gestational age or prior prenatal care at other sites, for any age (including pregnant and postpartum minors), within outpatient obstetric (OB) visit at the hospital or in affiliated clinics; and labor and delivery (L&D)
Definition:
Not eligible for a cardiovascular disease (CVD) risk assessment with a standardized instrument – Patients with a prior history of known CVD. For the purposes of this measure, prior history of known CVD, is represented by code M1256.
The following codes would be sufficient to define CVD (ICD-10-CM): I05.2, I20.9, I21.09, I21.3, I21.B, I24, I24.0, I24.1, I24.81, I24.89, I24.9, I25.10, I25.42, I25.2, I25.84, I25.85, I25.9, I27, I27.0, I27.1, I27.20, I27.21, I27.22, I27.23, I27.24, I27.29, I27.81, I27.82, I27.83, I27.89, I27.9, I34, I34.0, I34.1, I34.2, I34.81, I34.89, I34.9, I35, I35.0, I35.1, I35.2, I35.8, I35.9, I36, I36.0, I36.1, I36.2, I36.8, I36.9, I37, I37.0, I37.1, I37.2, I37.8, I37.9, I38, I42.0, I42.2, I42.8, I45, I45.0, I45.10, I45.19, I45.2, I45.3, I45.4, I45.5, I45.6, I45.81, I45.89, I45.9, I47.1, I47.10, I47.11, I47.19, I47.2, I47.20, I47.21, I47.29, I48.91, I48.92, I49.1, I49.3, I49.8, I49.9, I50.30, I50.9, I77.810, I97.190, M30.3, O90.3, O99.411, O99.412, O99.413, O99.419, Q20.0, Q20.1, Q20.3, Q20.4, Q20.8, Q21.0, Q21.20, Q21.3, Q22.1, Q23.0, Q23.2, Q24.5, Q25.0, Q25.1, Q25.44, Q25.5, Q25.6, Q26.3, Q87.40, Q87.89, Z82.49, Z86.79, Z87.74, Z86.79, Z87.74
DENOMINATOR NOTE: The intent of the measure is to have all pregnant and/or postpartum patients undergo CVD risk assessment at least once during the pregnancy episode.
Denominator Criteria (Eligible Cases):
All patients regardless of age
AND
Diagnosis for Pregnancy or Postpartum (ICD-10-CM): Z37, Z37.0, Z37.1, Z37.2, Z37.3, Z37.4, Z37.5, Z37.50, Z37.51, Z37.52, Z37.53, Z37.54, Z37.59, Z37.6, Z37.60, Z37.61, Z37.62, Z37.63, Z37.64, Z37.69, Z37.7, Z37.9
AND
Encounter for pregnancy (CPT): 59400, 59409, 59410, 59412, 59510, 59514, 59515, 59610, 59612, 59614, 59618, 59620
OR
Patient visits during the performance period (CPT): 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99238, 99239
AND NOT
DENOMINATOR EXCLUSIONS:
Patients who have another reason for visiting the clinic [not prenatal or postpartum care] and have a positive pregnancy test but have not established the clinic as an OB provider (e.g., plan to terminate the pregnancy or seek prenatal services elsewhere): M1255
OR
Prior history of known CVD: M1256
Numerator
Patients who are assessed for CVD risk via California Maternal Quality Care Collaborative (CMQCC) standardized algorithm. A completed CVD risk assessment will determine the patient to be at low risk or high risk of CVD. Patients will be assessed at their initial encounter with their healthcare provider for pregnancy-related care [prenatal visit, L&D, postpartum visit] and may need to repeat assessments if new symptoms develop.
Definition:
CMQCC CVD risk assessment algorithm is an example of a standardized CVD risk assessment algorithm. This is currently the only pregnancy specific algorithm. The CMQCC CVD risk assessment tool kit can be found at https://www.cmqcc.org/resources-toolkits/toolkits/improving-health-care-response-cardiovascular-diseasepregnancy-and.
Numerator Options:
Performance Met: CVD risk assessment performed, have a documented calculated risk score (M1258)
OR
Performance Not Met: CVD risk assessment not performed or incomplete (e.g., CVD risk assessment was not documented), reason not otherwise specified) (M1257)
Rationale
Cardiovascular disease (CVD) has emerged as the leading cause of maternal mortality in the United States, accounting for over one-third of all pregnancy-related deaths. Diagnosis of CVD is challenging as normal pregnancy may mimic CVD. Accurate diagnosis of CVD varies widely among pregnant and postpartum patients and may either result in a lack of follow-up patients who are at risk or may lead to unnecessary testing that burdens the resources of patients who are not at risk. Patients who are identified at immediate or lifetime risk of developing CVD may be motivated to modify their behavior to improve their cardiovascular health.
Our measure is used for standardized identification of pregnant and/or postpartum individuals with previously unknown CVD who are suspected to have or to be at risk of developing CVD. A CVD risk assessment distinguishes patients with a high probability of disease by analyzing several variables included in the tool.
For a universal use of cardiovascular risk assessment in pregnant and postpartum women, a reliable clinical screening approach that monitors the hospital and clinician performance is lacking. The implementation of a measure to perform universal CVD risk assessment in the obstetric population will lead to timely identification and follow-up of women at risk of CVD and reduce maternal morbidity and mortality. This will help decrease the lifetime onset of CVD through risk factor modification strategies.
The implementation of the measure at facilities and feedback on performance has raised awareness of the importance of CVD risk assessment among obstetricians. The easy use (takes less than one minute to complete CVD risk assessment) of the tool allows for integration into the clinic flow and provides an opportunity to discuss with patient actions to improve their cardiovascular during pregnancy and beyond. We have not seen any evidence that the followup of patients who were deemed at high risk for CVD led to inappropriate use of resources (Hameed et al, 2023).
Clinical Recommendation Statements
Delays or missed diagnosis of CVD in pregnant and postpartum patients is the leading contributor to CVD related maternal mortality. Implementation and universal CVD risk assessment using a standardized tool would allow identification of patients at high risk of CVD that require additional cardiac testing and follow-up. We propose implementation of metrics on adherence to the standard risk assessment tool that allows clinicians to add value to the obstetric care of patients. The measure is user friendly and can easily be calculated for the hospital system, the clinic group/facilities, or to monitor individual clinician performance. The measure allows for the identification of lowperforming hospital systems, facilities, or clinicians and addresses modifiable gaps (Kuklina et al, 2011; Small et al, 2012).