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.
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Risk scores and ICD-10-CM diagnosis codes for obstetric comorbidities in relation to severe maternal morbidity (SMM) and non-transfusion SMMa |
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Factor |
Score for SMM |
Score for non-transfusion SMM |
ICD-10-CM Diagnosis Codeb |
|
Placenta accreta spectrum |
59 |
36 |
O43.213, O43.223, O43.233 |
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Pulmonary hypertension |
50 |
32 |
I27.0, I27.2 |
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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 |
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Bleeding disorder, preexisting |
34 |
23 |
D66, D67, D68.0-D68.6, D69 |
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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 |
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HIV/AIDS |
30 |
13 |
O98.7, B20 |
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Placenta previa, complete or partial |
27 |
13 |
O44.03, O44.13, O44.23, O44.33 |
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Preeclampsia with severe features |
26 |
16 |
O14.1, O14.2, O11 |
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Anemia, preexisting |
20 |
7 |
O99.01, O99.02, D50, D55, D56, D58, D59, D57.1, D57.20, D57.3, D57.40, D57.80 |
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Twin/multiple pregnancy |
20 |
8 |
O30, O31, Z37.2-Z37.7 |
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Placental abruption |
18 |
7 |
O45 |
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Preterm birth (< 37 weeks) |
18 |
12 |
Z3A.20-Z3A.36 |
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Gastrointestinal disease |
12 |
8 |
K50-K52, K70-K77, K80-K83, K85-K87, K94, K95, O26.6 |
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Preeclampsia without severe features or gestational hypertension |
11 |
6 |
O13, O14.0, O14.9 |
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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 |
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Substance use disorder |
10 |
5 |
F10-F19, O99.31, O99.32 |
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Connective tissue or autoimmune disease |
10 |
7 |
M30-M36 |
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Chronic hypertension |
10 |
7 |
O10, O11, I10 |
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Preexisting diabetes mellitus |
9 |
6 |
E08-E13, O24.0, O24.1, O24.3, O24.8, O24.9, Z79.4 |
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Neuromuscular disease |
9 |
8 |
G40, G70 |
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Major mental health disorder |
7 |
4 |
F06, F20-F25, F28-F34, F39, F40.0, F41, F43, F53, F60 |
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Thyrotoxicosis |
6 |
0 |
E05 |
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Delivery BMI ≥ 40 |
5 |
4 |
Z68.4 |
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Previous cesarean birth |
4 |
0 |
O34.21 |
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Maternal age ≥ 35 years |
2 |
1 |
Birth certificate |
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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)
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CDC severe maternal morbidity indicators and corresponding ICD-10-CM codes during delivery and postpartum hospitalizations. |
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Severe Maternal Morbidity Indicator |
Diagnosis (DX) or Procedure (PR) |
ICD-10-CM |
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Acute myocardial infarction |
DX |
I21.xx, I22.x |
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Aneurysm |
DX |
I71.xx, I79.0 |
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Acute renal failure |
DX |
N17.x, O90.4 |
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Adult respiratory distress syndrome |
DX |
J80, J95.1, J95.2, J95.3, J95.82x, J96.0x, J96.2x R09.2 |
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Amniotic fluid embolism |
DX |
O88.1x |
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Cardiac arrest/ventricular fibrillation |
DX |
I46.x, I49.0x |
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Conversion of cardiac rhythm |
PR |
5A2204Z, 5A12012 |
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Disseminated intravascular coagulation |
DX |
D65, D68.8, D68.9, O72.3 |
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Eclampsia |
DX |
O15.x |
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Heart failure or arrest during surgery or procedure |
DX |
I97.12x, I97.13x, I97.710, I97.711 |
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Puerperal cerebrovascular disorders |
DX |
I60.xx-I68.xx, O22.51, O22.52, O22.53, I97.81x, I97.82x, O87.3 |
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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 |
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Severe anesthesia complications |
DX |
O74.0 , O74.1 , O74.2, O74.3, O89.0x, O89.1, O89.2 |
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Sepsis |
DX |
O85, O86.04, T80.211A, T81.4XXA, T81.44xx, R65.20, A40.x, A41.x, A32.7 |
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Shock |
DX |
O75.1, R57.x, R65.21, T78.2XXA, T88.2 XXA, T88.6 XXA, T81.10XA , T81.11XA, T81.19XA |
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Sickle cell disease with crisis |
DX |
D57.0x, D57.21x, D57.41x, D57.81x |
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Air and thrombotic embolism |
DX |
I26.x, O88.0x, O88.2x, O88.3x, O88.8x |
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Blood transfusion |
PR |
30233, 30240, 30243a |
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Hysterectomy |
PR |
0UT90ZZ, 0UT94ZZ, 0UT97ZZ, 0UT98ZZ, 0UT9FZZ, 0UT90ZL |
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Temporary tracheostomy |
PR |
0B110Z, 0B110F, 0B113, 0B114 |
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Ventilation |
PR |
5A1935Z, 5A1945Z, 5A1955Z |
Reference: CDC. Severe maternal morbidity indicators and corresponding ICD codes during delivery hospitalizations. Updated March 6, 2020.