Obstetric Comorbidity Scoring System

Below is information to implement the obstetric comorbidity scoring system in any data set that includes ICD-10-CM codes and patient age. As an example, a patient with ICD-10-CM codes indicating preexisting cardiac disease and chronic hypertension would receive comorbidity scores of 41 for SMM risk (31+10) and 29 for non-transfusion SMM risk (22+7). (Note that the scores for SMM and non-transfusion SMM cannot be directly compared as they were developed separately.) The goal for these scoring systems is to facilitate improved comparisons SMM rates and non-transfusion SMM rates between hospitals.

Risk scores and ICD-10-CM diagnosis codes for obstetric comorbidities in relation to severe maternal morbidity (SMM) and non-transfusion SMMa 

Factor

Score for SMM

Score for non-transfusion SMM

ICD-10-CM Diagnosis Codeb

Placenta accreta spectrum

59

36

O43.2

Pulmonary hypertension

50

32

I27.0, I27.2

Chronic renal disease

38

26

O26.83, I12, I13, N03-N05, N07, N08, N11.1, N11.8, N11.9, N18, N25.0, N25.1, N25.81, N25.89, N25.9, N26.9

Bleeding disorder, preexisting

34

23

D66-D69

Cardiac disease, preexisting

31

22

I05-I09, I11-I13, I15, I16, I20, I25, I27.8, I30-I41, I44-I49, I50.22, I50.23, I50.32, I50.33, I50.42, I50.43, I50.812, I50.813 O99.41, O99.42, Q20-Q24

HIV/AIDS

30

13

O98.7, B20

Placenta previa, complete or partial

27

13

O44.03, O44.13, O44.23, O44.33

Preeclampsia with severe features

26

16

O14.1, O14.2, O11

Anemia, preexisting

20

7

O99.01, O99.02, D50, D55, D56, D57.1, D57.20, D57.3, D57.40, D57.80, D55, D56, D58, D59

Twin/multiple pregnancy

20

8

O30, O31, Z37.2-Z37.7

Placental abruption

18

7

O45

Preterm birth (< 37 weeks)

18

12

Z3A.20-Z3A.36

Gastrointestinal disease

12

8

K (entire block), O99.6, O26.6

Preeclampsia without severe features or gestational hypertension

11

6

O13, O14.0, O14.9

Asthma, acute or moderate/severe

11

9

O99.5, J45.21, J45.22, J45.31, J45.32, J45.4, J45.5, J45.901, J45.902

Substance use disorder

10

5

F10-F19, O99.31, O99.32

Connective tissue or autoimmune disease

10

7

M30-M36

Chronic hypertension

10

7

O10, O11, I10

Preexisting diabetes mellitus

9

6

E08-E13, O24.0, O24.1, O24.3, O24.8, O24.9, Z79.4

Neuromuscular disease

9

8

O99.35, G40, G70

Major mental health disorder

7

4

O99.34, F20-F39

Thyrotoxicosis

6

0

E05

Delivery BMI ≥ 40

5

4

Z68.4

Previous cesarean birth

4

0

O34.21

Maternal age ≥ 35 years

2

1

Birth certificate

Gestational diabetes mellitus

1

1

O24.4

a Cases of transfusion only treated as non-SMM cases

b Any parent code is inclusive of all child codes (e.g., O43.2 includes O43.211…O43.239)
 

CDC severe maternal morbidity indicators and corresponding ICD-10-CM codes during delivery and postpartum hospitalizations.

Severe Maternal Morbidity Indicator

Diagnosis (DX) or Procedure (PR)

ICD-10-CM

Acute myocardial infarction

DX

I21.xx, I22.x

Aneurysm

DX

I71.xx, I79.0

Acute renal failure

DX

N17.x, O90.4

Adult respiratory distress syndrome

DX

J80, J95.1, J95.2, J95.3, J95.82x, J96.0x, J96.2x R09.2

Amniotic fluid embolism

DX

O88.1x

Cardiac arrest/ventricular fibrillation

DX

I46.x, I49.0x

Conversion of cardiac rhythm

PR

5A2204Z, 5A12012

Disseminated intravascular coagulation

DX

D65, D68.8, D68.9, O72.3

Eclampsia

DX

O15.x

Heart failure or arrest during surgery or procedure

DX

I97.12x, I97.13x, I97.710, I97.711

Puerperal cerebrovascular disorders

DX

I60.xx-I68.xx, O22.51, O22.52, O22.53, I97.81x, I97.82x, O87.3

Pulmonary edema / acute heart failure

DX

J81.0, I50.1, I50.20, I50.21, I50.23, I50.30, I50.31, I50.33, I50.40, I50.41, I50.43, I50.9

Severe anesthesia complications

DX

O74.0 , O74.1 , O74.2, O74.3, O89.0x, O89.1, O89.2

Sepsis

DX

O85, O86.04, T80.211A, T81.4XXA, T81.44xx, R65.20, A40.x, A41.x, A32.7

Shock

DX

O75.1, R57.x, R65.21, T78.2XXA, T88.2 XXA, T88.6 XXA, T81.10XA , T81.11XA, T81.19XA

Sickle cell disease with crisis

DX

D57.0x, D57.21x, D57.41x, D57.81x

Air and thrombotic embolism

DX

I26.x, O88.0x, O88.2x, O88.3x, O88.8x

Blood transfusion

PR

30233, 30240, 30243a

Hysterectomy

PR

0UT90ZZ, 0UT94ZZ, 0UT97ZZ, 0UT98ZZ, 0UT9FZZ, 0UT90ZL

Temporary tracheostomy

PR

0B110Z, 0B110F, 0B113, 0B114

Ventilation

PR

5A1935Z, 5A1945Z, 5A1955Z

Reference: CDC. Severe maternal morbidity indicators and corresponding ICD codes during delivery hospitalizations. Updated March 6, 2020.