Cesarean Rate for Low Risk, First Birth Women (NTSV CS Rate)

NQF Measure Number and Title: #-471 PC-02 Cesarean Section

Brief Description of the Measure

This measure assesses the number of nulliparous women with a term, singleton baby in a vertex position delivered by cesarean section. This measure is part of a set of five nationally implemented measures that address perinatal care (PC-01: Elective Delivery, PC-03: Antenatal Steroids, PC-04: Health Care-Associated Bloodstream Infections in Newborns, PC-05: Exclusive Breast Milk Feeding).

Denominator Statement

Nulliparous patients delivered of a live term singleton newborn in vertex presentation.

Denominator Details

Ten data elements are used to calculate the denominator:
1. Admission Date – The month, day and year of admission to acute inpatient care.
2. Birthdate - The month, day and year the patient was born.
3. Clinical Trial - Documentation that during this hospital stay the patient was enrolled in a clinical trial in which patients with pregnancy were being studied. Allowable values: Yes or No/UTD
4. Discharge Date – The month day and year the patient was discharged from acute care, left against medical advice or expired during the stay.
5. Gestational Age – Documentation of the weeks of gestation completed at the time of delivery. Allowable Values: 1-50 or UTD.
6. ICD-9-CM Other Diagnosis Codes - The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes associated with the secondary diagnoses for this hospitalization.
7. ICD-9-CM Other Procedure Codes - The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code that identifies significant procedures performed other than the principal procedure during this hospitalization.
8. ICD-9-CM Principal Diagnosis Code - The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code associated with the diagnosis established after study to be chiefly responsible for occasioning the admission of the patient for this hospitalization.
9. ICD-9-CM Principal Procedure Code - The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code that identifies the principal procedure performed during this hospitalization. The principal procedure is the procedure performed for definitive treatment rather than diagnostic or exploratory purposes, or which is necessary to take care of a complication.
10. Parity - The number of deliveries, whether resulting in live or stillborn infants, the patient experienced prior to current hospitalization. Allowable Values: 0-50 or UTD.

Denominator Exclusions

• ICD-9-CM Principal Diagnosis Code or ICD-9-CM Other Diagnosis Codes for contraindications to vaginal delivery as defined in Appendix A, Table 11.09
• Less than 8 years of age
• Greater than or equal to 65 years of age
• Length of Stay >120 days
• Enrolled in clinical trials

Numerator Statement

Patients with cesarean sections with ICD-9-CM Principal Procedure Code or ICD-9-CM Other Procedure Codes for cesarean section as defined in Appendix A, Table 11.06 available at: http://manual.jointcommission.org 

Numerator Detail

Two data elements are used to calculate the numerator:
1. ICD-9-CM Other Procedure Codes - The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code that identifies significant procedures performed other than the principal procedure during this hospitalization.
2. ICD-9-CM Principal Procedure Code - The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code that identifies the principal procedure performed during this hospitalization. The principal procedure is the procedure performed for definitive treatment rather than diagnostic or exploratory purposes, or which is necessary to take care of a complication.
Patients are eligible for the numerator population with ICD-9-CM Other Procedure Codes or ICD-9-CM Principal Procedure Code for cesarean section. If none of these codes is present, patients are in the denominator population only.

For more information, see NQF Measure Submission and Evaluation Worksheet on NQF #0471 PC-02