safe deliveries roadmap measures for wsha-md and wsha-q s ... · 11/7/2017 · procedure code or...

Safe Deliveries Roadmap Measures for WSHA-MDC and WSHA-QBS:

Numerator and Denominator Specifications (version 11-2017 update)

This document is intended for the following hospital options for source of measurement data: 1. WSHA-MDC system: Hospitals submit administrative Patient Discharge Data (PDD) and Core Clinical Maternal and Newborn Data to WSHA-

CMDC system which then calculates measure rates based on definitions below and provides secure web-interface for focused supplemental

chart review where indicated for selected measures. Core Clinical Maternal and Newborn data files are special names given to supplemental

data files with specific data elements required for submission of data to WSHA-CMDC.

2. WSHA-QBS system: Hospitals submit to WSHA-QBS System their own numerator and denominator values for each measure based on

definitions below, internal hospital data analyst support and supplemental chart review data where indicated.

Summary of Changes and Updates Since Last Update (November 2016):

New maternal and newborn balance measures:

• Transfusion rate for delivering women with post-partum hemorrhage (#5d).

Measure with continued additional importance of supplemental data to identify transfusions if hospital Coding Department no longer

codes blood transfusions:

• Maternal blood transfusions (Safe Deliveries Roadmap measures #5a, 5b, 5c, 5d).

Measures with updated ICD-10 codes or other modifications:

• Severe Maternal Morbidity (with and without transfusions) among all deliveries and among two subgroups: with diagnosis of Hemorrhage;

with diagnosis of Preeclampsia – CDC AIM SMM Measures 2017; #s 11,12,13 (please refer to most recent version on WSHA website)

• Unexpected Newborn Complications (some long length of stay for newborn requirements added for some of sub-measures such as Severe

Respiratory UNC with CPAP use-see most recent UNC appendix on WSHA website)

• Maternal blood transfusions (some ICD10 codes added to list-complete list at the end of this document)

Version November 7, 2017 p. 2

• Maternal Chorioamnionitis or Newborn affected by chorioamnionitis (maternal pyrexia-fever during labor ICD code removed from numerator

definition-see appendix posted on WSHA website)

• Newborn with severe complication among inborn term newborns with maternal shoulder dystocia diagnosis at delivery (linked mother-baby

record measure) (severe complications now align with severe unexpected newborn complications-UNC numerator; see appendix posted on

WSHA website))

Measure category continued change from “outcome” measure to “utilization” measure:

• Long Postpartum Length of Stay for Vaginal or Cesarean Deliveries is being re-categorized to a Safe Deliveries Roadmap Utilization Measure

(6.a and 6.b.) (optional).

Retired or Optional Measures:

• Maternal ICU Days per all deliveries (4b) and ICU Days for women with Preeclampsia diagnosis (9b) were retired November 2016. Maternal

admission to ICU for women with Preeclampsia diagnosis has been changed to an optional measure as these cases are already captured by

Maternal admission to ICU for all delivering women.

• Severe Maternal Morbidity among delivering women with Pre-eclampsia (CMQCC Measure) was replaced in November 2016 by the new CDC-

AIM Severe Maternal Morbidity with Pre-eclampsia measure.

Other previous changes made November 2016:

• The lower gestational age cut-off of <=20 weeks gestational age was removed from the relevant measures to decrease measure calculation

burden (#s 4, 5a, 5b, 5c, 6a, 6b, 9, 10).

• Modifications to Induction of Labor-related and Transfusion measures were made in December 2015 due to:

1. Gaps in direct mapping of ICD-9 to ICD-10 coding for Induction of Labor:

▪ Induction of Labor Measures: continued required supplemental data field “Induced” (Yes / No) as of October 2015. The

addition of a clinical “Induced” data element enables continued calculation of the two outcome measures for CS Rates for

Term Inductions of Labor in Multiparous and Nulliparous Women >= 39 Week as a data supplement bridge until the national

Coding group restores ICD code specific to Induction of Labor (distinct from augmentation and AROM) which had been

available with ICD-9-CM codes.

2. Updated national measure specifications for two maternal blood transfusion-related measures. This update was also provided in the

December 2015 document, but is repeated here due to on-going importance:

▪ Transfusion Measures: two of the optional Safe Deliveries Roadmap transfusion measures have been aligned with national

measures from CMS and Joint Commission. Changes have occurred nationally to the blood product types captured for these

measures. Washington State Safe Deliveries Roadmap made changes to these two measures to align with the national

measures starting October 2015:

1) CMS OB Adverse Event Measure (original measure defined by CMS in 2014): Total number of blood products

transfused per 1,000 delivering mothers. This measure has been changed to focus on RBC and FFP units only (platelets

and cryoprecipitate packs will no longer counted because of variations in these unit volumes).


2) Joint Commission Maternal Sentinel Event-Massive Blood Transfusion >= 4 units: This measure is now focused on RBCs

only (FFP, platelets, and cryoprecipitate packs will not be included per this Joint Commission Maternal Sentinel Event

definition).

# Outcome Measure

Name Numerator Description

Denominator Description

Definition Source

Data Source Numerator Specifications Denominator Specifications

1 Nulliparous Term Singleton Vertex Cesarean Section Rate (NTSV)

All cesarean deliveries among the denominator.

Nulliparous (first birth) women > 37 weeks. Exclude: breech or transverse presentation, preterm births, fetal deaths, and multiple gestations.

Joint Commission PC-02 current for the time period.

Patient Discharge Data Plus Gestational Age at Delivery, and Parity From either: Core Clinical Maternal data OR Birth Certificate data.

Cases among the denominator who had cesarean delivery. Include: ICD-10-PCS Principal Procedure Code or ICD-10-PCS Other Procedure Codes for cesarean section as defined in Appendix A, Table 11.06:

• 10D00Z0 Classical cesarean

• 10D00Z1 Low cervical cesarean

• 10D00Z2 Extraperitoneal cesarean

Exclude: None

Nulliparous patients delivering live term singleton newborn in vertex presentation. This measure definition is based on the most recent Joint Commission definition and specifications. Include: ICD10 procedure codes for delivery (Appendix A, Table 11.01.1 and Singleton Outcome of delivery (Appendix A, Table 11.08) Also restrict above Deliveries to: Parity = 0. Gestational Age >= 37 weeks at delivery. Exclude: ICD-10-CM Principal Diagnosis Code or ICD-10-CM Other Diagnosis Codes, for contraindications to vaginal delivery (Appendix A, Table 11.09) Also Exclude:

• Less than 8 yrs of age

• Greater than or equal to 65 yrs of age

• Length of stay >120 days

• Enrolled in clinical trials

2 Primary Term Singleton Vertex (TSV) Cesarean Section Rate


Delivering women > 37 weeks who have not had a prior cesarean section.

AHRQ IQI-33 “Primary Cesarean Delivery Rate, Uncomplicated”

Patient Discharge Data Plus Gestational age at Delivery

Cesarean delivery among the denominator defined by either Cesarean Delivery DRG, MS-DRG or ICD-10-CM procedure codes defined by DRG codes:

• 370 Cesarean w cc,

Include: All deliveries, identified by DRG, MS-DRG or ICD-10 codes defined by: DRG Codes:

• 370 Cesarean w cc

• 371 Cesarean w/o cc

• 372 Vaginal del w cc


# Outcome Measure



Definition Source


Exclude: breech or transverse presentation, preterm births, fetal deaths, and multiple gestations.

From either: Core Clinical Maternal data OR Birth Certificate data. When birth certificate data available add to exclusions: Previous c-section (# 57.7 on Birth Certificate).

• 371 Cesarean c/o cc OR MS-DRG codes:

• 765 Cesarean w cc/mcc

• 766 Cesarean w/o cc/mcc

OR ICD-10 Cesarean Delivery Procedure Codes:




• 373 Vaginal del w/o cc

• 374 Vaginal del w sterilization &/or D&C

• 375 Vaginal del w operating room proc except steril &/or D&C

OR MS-DRG codes:




• 768 Vaginal del w OR proc except steril &/or D&C


• 775 Vaginal del w/o cc OR ICD10 Base Deliveries (see end of document for complete code list) Exclude from above Deliveries cases with:

• Gestational Age < 37 weeks at delivery

• Any listed ICD-10-CM diagnosis code for contraindication to vaginal delivery: abnormal presentation, breech, preterm, fetal death, or multiple gestation (see Appendix for detail on ICD-10 codes)

• Any listed ICD-10-CM diagnosis code for Previous Cesarean delivery (034.21 Maternal care for scar from previous cesarean delivery)

SEE “TWO APPENDIX DOCUMENTS FOR PRIMARY TERM SINGLETON VERTEX CESAREAN RATE” FOR COMPLETE LIST OF CODES.

3a C-Section rate for Term Inductions of Labor in Nulliparous women >= 39 weeks gestation at delivery


Nulliparous women whose labor was induced with delivery >= 39

WSHA Safe Deliveries Roadmap

Patient Discharge Data Plus

Discharges among the denominator with either: DRG, MS-DRG, or ICD-10-CM procedure codes for Cesarean delivery. DRG codes:

Include all delivering women identified by ICD-10 codes ICD10 Base Deliveries (see end of document for complete code list)


# Outcome Measure



Definition Source


weeks gestation.

Gestational Age at delivery and Parity From either: Core Clinical Maternal data: OR Birth Certificate data and Induction of Labor (Y/N) from either Supplemental Maternal Data, internal data, or chart review data.


• 371 Cesarean c/o cc OR MS-DRG codes:







AND Restricted to Parity = 0. Gestational Age >= 39 weeks at delivery. Induction of Labor (based on supplemental Maternal Data from internal electronic or manual data)

3b C-Section rate for Term Inductions of Labor in Multiparous women >= 39 weeks gestation at delivery


Multiparous women whose labor was induced with delivery >= 39 weeks gestation.


Patient Discharge Data Plus Gestational Age at delivery and Parity From either: Core Clinical Maternal data OR Birth Certificate data and Induction of Labor (Y/N) from either Supplemental Maternal Data, internal

Discharges among the denominator with either: DRG or MS-DRG codes for Cesarean delivery; or Any listed ICD-10-CM procedure codes for Cesarean delivery. Cesarean Delivery DRG codes:


• 371 Cesarean c/o cc OR Cesarean Delivery MS-DRG codes:





Include all delivering women identified by ICD-10 codes ICD10 Base Deliveries (see end of document for complete code list) AND restricted to Parity >=1. Gestational Age >= 39 weeks at delivery. Induction of Labor (based on supplemental Maternal Data from internal electronic or manual data)


# Outcome Measure



Definition Source


data or chart review data.



4 Number of Maternal admissions to ICU per all deliveries

All maternal admissions to ICU anytime during delivery hospitalization among the denominator.

Women with delivery excluding ectopics and miscarriages


Patient Discharge Data including Billing Revenue Code data (for ICU stay).

Discharges among the denominator who had an ICU admission during their stay as identified by either: Any Revenue Charge code in Accommodations 0200 series (ICU) from PDD. OR IF REVENUE CODES NEED SUPPORT FROM SUPPLEMENTAL DATA: ICU_days > 0. For WSHA-CMDC system: data in Maternal Supplemental Clinical Data OR For WSHA-QBS system: data from other internal hospital data source.

Include all delivering women excluding ectopics and miscarriages identified by ICD-10 codes: ICD10 Base Deliveries (see end of document for complete code list)

5a Percent of delivering women who received a blood transfusion

Number of women among the denominator who received any transfusion of blood products (RBC, FFP, Platelet packs, Cryoprecipitate) identified by ICD-10-CM procedure codes from among the denominator.

Women who delivered excluding ectopics and miscarriages.


Patient Discharge Admin Data Plus If procedure codes in PDD need supplemental backup: transfusions with validation from hospital lab, blood bank, transfusion log book OR optional chart review for

Among the denominator, number of patients with any ICD-10 Procedure code for specific transfusions identified by ICD-10 codes, listed at the end of this document.

Include all delivering women excluding ectopics and miscarriages identified by ICD-10 codes ICD10 Base Deliveries (see end of document for complete code list)


# Outcome Measure



Definition Source


blood transfusion data via WSHA-CMDC System Interface or WSHA-QBS: internal hospital chart review.

5b Total number of blood products transfused per delivering women

OPTIONAL

Number of blood product units transfused from among the denominator.

Women who delivered excluding ectopics and miscarriages


Patient Discharge Admin Data Plus If procedure codes in PDD need supplemental backup: transfusions with validation from hospital lab, blood bank, transfusion log book OR optional chart review for blood transfusion data via WSHA-CMDC System Interface or WSHA-QBS: internal hospital chart review.

Among the denominator number of blood products transfused by each type and total: RBCs and FFP. Identified by either: Revenue code 0380 series for transfusion blood units/types and associated Service Unit –counts OR HCPC charge code for type and associated Service Units counts OR From Maternal Supplemental Clinical File: number of units transfused for RBCs, FFP, Platelets and Cryoprecipitate OR OPTIONAL chart review via: WSHA-CMDC: secure chart review web interface OR WSHA-QBS: other hospital chart review source. Calculated per 1,000 cases in the denominator.

Include all delivering women excluding ectopics and miscarriages identified by ICD-10-CM codes ICD10 Base Deliveries (see end of document for complete code list)


# Outcome Measure



Definition Source


5c Total number of massive blood transfusions (>= 4 units RBCs) per delivering women

OPTIONAL

Number of delivering women who received >= 4 units of blood products (RBCs) per delivering women.

Women who delivered calculated per delivering women excluding ectopics and miscarriages.

WSHA Safe Deliveries Roadmap harmonized with Joint Commission Maternal Sentinel Event-Massive Transfusions

Patient Discharge Data Plus If procedure codes in PDD need supplemental backup: back-up validation from hospital lab, blood bank, transfusion log book or optional chart review for blood transfusion data via WSHA-CMDC Interface or WSHA-QBS: internal hospital chart review.

Among the denominator number of patients with >= 4 units RBCs transfused as identified by either: Revenue code 0380 series for transfusion blood units/types and associated Service Unit –counts OR HCPC charge code for RBCs, FFP, Platelets, and Cryoprecipitate and associated Service Units per type >= 4 units (counts) per patient. OR From Maternal Supplemental Clinical File: >= 4 units transfused for RBCs, FFP, Platelets and Cryoprecipitate per patient. OR Optional hospital chart review via: WSHA-CMDC: secure web interface OR WSHA-QBS: other hospital chart review source. Calculated per 1,000 cases in the denominator.

Include all delivering women excluding ectopics and miscarriages identified by ICD-10 codes ICD10 Base Deliveries (see end of document for complete code list)

5d Percent of women with post-partum hemorrhage who received a blood transfusion

Number of women among the denominator who received any transfusion of blood products (RBC, FFP, Platelet packs, Cryoprecipitate)

Number of delivering women excluding ectopics and miscarriages who had a post-partum hemorrhage


Patient Discharge Admin Data If ICD procedure codes are not provided by hospital coders and therefore are not present in

Among the denominator, number of patients with any ICD-10 Procedure code for specific transfusions identified by ICD-10 codes, listed at the end of this document.

Include all delivering women excluding ectopics and miscarriages with postpartum hemorrhage identified by ICD10 codes Start with ICD10 Base Deliveries (see end of document for complete code list) Then restrict above Base deliveries to those with post-partum hemorrhage


# Outcome Measure



Definition Source


identified by ICD-10-CM procedure codes from among the denominator.

administrative data, provide supplemental transfusion data backup, e.g. transfusions from hospital lab, blood bank, transfusion log book OR optional chart review for blood transfusion data via WSHA-CMDC System Interface or WSHA-QBS: internal hospital chart review. (Note: this change needs MDC programming)

codes (see end of document for complete code list postpartum hemorrhage)

6a Percent of women with LOS >= 4 days from delivery to discharge per women who delivered vaginally

UTILIZATION MEASURE OPTIONAL

Number of women with LOS >= 4 days from date of delivery to discharge date among the denominator.

All delivering women who delivered vaginally, excluding ectopics and miscarriages


Patient Discharge Data Plus Date of newborn birth Identified by either: Core Clinical Newborn and Maternal data OR

Discharges among the denominator with maternal length of stay from delivery day to discharge date >= 4 days.

Include all women delivering vaginally excluding ectopics and miscarriages identified by ICD-10 codes ICD10 Base Deliveries (see end of document for complete code list) then also filter out cesarean deliveries Method to filter out all but vaginal deliveries by ICD-10 codes: Step 1: Start with All Base Delivery ICD-10 codes excluding ectopics and miscarriages


# Outcome Measure



Definition Source


Birth certificate data.

Step 2: Exclude cases with procedure codes for Cesarean Delivery (Table 11.06 codes):



• 10D00Z2 Extraperitoneal cesarean. Step 3: Cases remaining are with vaginal delivery.

6b Percent of women with LOS >= 6 days from delivery to discharge per women who delivered by cesarean section

UTILIZATION MEASURE OPTIONAL

Number of women with LOS >= 6 days from delivery to discharge among the denominator.

All delivering women who delivered by cesarean section.


Patient Discharge Data Plus Date of newborn birth Identified by either: Core Clinical Newborn and Maternal data OR Birth certificate data.

Discharges among the denominator with maternal length of stay from delivery day to discharge date >= 6 days.

Include all women delivering excluding ectopics and miscarriages identified by ICD-10 codes ICD10 Base Deliveries (see end of document for complete code list) then also filter out cesarean deliveries Then further restrict above deliveries to those who had cesarean delivery. Cesarean Delivery Procedure Codes 10D00Z0 Classical cesarean 10D00Z1 Low cervical cesarean 10D00Z2 Extraperitoneal cesarean

7 Percent of operative vaginal deliveries per all vaginal deliveries

Number of operative deliveries by forceps or vacuum from among the denominator.

Number of vaginal deliveries excluding ectopics and miscarriages


Patient Discharge Data.

From among the denominator Operative Assisted delivery with Instrument (forceps or vacuum):

• 10D07Z3 Low forceps

• 10D07Z4 Mid forceps

• 10D07Z5 High forceps

• 10D07Z6 Vacuum

• 10D07Z8 Other specified or unspecified instrument

Include all women delivering vaginally excluding ectopics and miscarriages identified by ICD10 Base Deliveries (see end of document for complete code list) then filter out cesarean deliveries Method to filter out all but vaginal deliveries by ICD-10 codes: Step 1: Start with All Base Delivery ICD-10 codes Step 2: Exclude cases with procedure codes for Cesarean Delivery:



• 10D00Z2 Extraperitoneal cesarean. Step 3: Cases remaining are with vaginal delivery.


# Outcome Measure



Definition Source


8 Unexpected Newborn Complications (UNCs) per live births (Inborn) NQF 716 Total rate per live births with two subgroups: A. Severe rate B. Moderate rate

Number of term neonates with any unexpected newborn complications (Total UNCs) among the denominator. Subgroup A: with any severe UNCs among the denominator. Subgroup B: with any moderate UNCs among the denominator.

Liveborn Inborn Term neonates w/o preexisting conditions calculated per 100 livebirths. Exclude: preterm, <2500gm, multiple gestations, all congenital anomalies, other fetal and placental conditions, exposure to maternal drug use (prescribed or illicit).

NQF 716. Use diagnosis and procedure codes plus supplemental data per NQF 716 measure definition (see Appendix)

Patient Discharge Data Plus linked mother-baby records, Plus 5 min Apgar, 10 min Apgar (if available), birth weight, and Gestational age at delivery. From either: Core Clinical Maternal and Newborn data OR birth certificate data.

From among the denominator: Total Complications per 100 in the denominator And two sub categories: Severe and Moderate (complications identified in hierarchical order SEE APPENDICES FOR DETAILS). Severe Complications from among the denominator identified by:

• Neonatal Death (by discharge disposition-death)

• Neonatal Transfer (by discharge disposition-transfer)

• 5’ or 10’ Apgar score <= 3 (by supplemental newborn file)

• Severe ICD-10 diagnosis or procedure code) (see Appendix)

Moderate Complications from among the denominator identified by: ICD-10 diagnosis and procedure codes (See Appendix)

SEE APPENDICES ON WSHA WEBSITE FOR UNEXPECTED NEWBORN COMPLICATIONS COMPLETE LIST OF CODES AND DEFINITIONS. Include Liveborn Inborn Term neonates w/o preexisting conditions as identified by Singleton Liveborn in hospital:

• >= 2500 gr BW (supplemental file)

• GA >= 37 weeks (supplemental linked maternal file)

From the above Appendices exclude:

• congenital anomalies

• other fetal / placental conditions

• exposure to maternal drug use- prescribed or illicit

9 For women with a diagnosis of Pre-eclampsia, percent of Maternal ICU Admissions

OPTIONAL

Number of delivering patients with any admission to ICU from among the denominator.

All women giving birth with any diagnosis code for preeclampsia.


Patient Discharge Data Plus Billing Revenue Code data (for ICU stay).

Among those in the denominator who had an ICU admission during their stay as identified by either: Any Revenue Charge code in Accommodations 0200 series (ICU) from PDD (Section B) OR ICU_days > 0 from Maternal Supplemental Clinical Data File.

Include all women delivering excluding ectopics and miscarriages identified by ICD-10 codes ICD10 Base Deliveries (see end of document for complete code list) AND further restrict to those with any diagnosis code for Preeclampsia, Severe preeclampsia, Eclampsia, or preeclampsia superimposed on pre-existing HTN:


# Outcome Measure



Definition Source


ICD-10-CM Codes:

• 014.00 Mild to moderate pre-eclampsia, unspecified trimester

• 014.02 Mild to moderate pre-eclampsia, second trimester

• 014.03 Mild to moderate pre-eclampsia, third trimester

• 014.90 Unspecified pre-eclampsia, unspecified trimester

• 014.92 Unspecified pre-eclampsia, second trimester

• 014.93 Unspecified pre-eclampsia, third trimester

• 011.1 Pre-existing hypertension with pre-eclampsia, first trimester

• 011.2 Pre-existing hypertension with pre-eclampsia, second trimester

• 011.3 Pre-existing hypertension with pre-eclampsia, third trimester

• 011.9 Pre-existing hypertension with pre-eclampsia, unspecified trimester

• 014.10 Severe pre-eclampsia, unspecified trimester

• 014.12 Severe pre-eclampsia, second trimester

• 014.13 Severe pre-eclampsia, third trimester

• 014.20 HELLP syndrome, unspecified trimester

• 014.22 HELLP syndrome, second trimester

• 014.23 HELLP syndrome, third trimester

• 015.00 Eclampsia in pregnancy, unspecified trimester

• 015.02 Eclampsia in pregnancy, second trimester

• 015.03 Eclampsia in pregnancy, third trimester

• 015.1 Eclampsia in labor

• 015.2 Eclampsia in the puerperium


# Outcome Measure



Definition Source


• 015.9 Eclampsia, unspecified as to time period

11 Severe Maternal Morbidity among delivering women

Among the denominator, all cases with any Severe Maternal Morbidity indicated by Diagnosis or Procedure (see CDC-AIM SMM Appendix for details).

All mothers during their birth admission, excluding ectopics and miscarriages (See CDC-AIM SMM Appendix for all ICD codes).

CDC AIM SMM Measure (2016)

Hospital Patient Discharge Data.

Among the denominator, number of women with Severe Maternal Morbidity (based on ICD-10 diagnosis-procedure codes. See APPENDIX for code lists): Diagnosis Codes for:

• Acute Myocardial Infarction

• Acute Renal Failure

• Adult Respiratory Distress

• Amniotic Fluid Embolism

• Aneurysm

• Cardiac Arrest

• Disseminated Intravascular Coagulation (DIC)

• Eclampsia

• Acute Heart Failure

• Puerperal Cerebrovascular Disorders

• Pulmonary Edema

• Severe Complications of Anesthesia

• Sepsis

• Shock

• Sickle Cell Crisis

• Air and Thrombotic Embolism

Procedure Codes for:

• Transfusion

• Conversion of Cardiac Rhythm

• Hysterectomy

• Temporary Tracheostomy

• Ventilation

Include all delivering women identified (excluding ectopics and miscarriages) by MS-DRG, or ICD-10 codes below (CDC/AIM definition) MS-DRG codes:






• 775 Vaginal del w/o cc OR ICD-10-CM Delivery codes PLEASE SEE CDC-AIM SMM APPENDIX ON WSHA WEBSITE FOR DETAILED LIST OF SEVERE MATERNAL MORBIDITY ICD-CODES FOR BOTH NUMERATOR AND DENOMINATOR


# Outcome Measure



Definition Source


12 Severe Maternal Morbidity among delivering women with Hemorrhage

Among the denominator, all cases with any Severe Maternal Morbidity Code (see CDC-AIM SMM Appendix).

All mothers during their birth admission, excluding ectopics and miscarriages, meeting one of the following criteria:

• Presence of an Abruption, Previa or Antepartum hemorrhage diagnosis code

• Presence of transfusion procedure code without a sickle cell crisis diagnosis code

• Presence of a Postpartum hemorrhage diagnosis code



Among the denominator number of women with Severe Maternal Morbidity (based on ICD-10 diagnosis-procedure codes): Diagnosis Codes for:





• Aneurysm

• Cardiac Arrest


• Eclampsia



• Pulmonary Edema


• Sepsis

• Shock




• Transfusion


• Hysterectomy


• Ventilation







• 775 Vaginal del w/o cc OR ICD-10-CM Delivery codes (see Appendix) AND Any code for presence of:

• Abruption

• Previa

• Antepartum hemorrhage diagnosis code

• Transfusion procedure code without a sickle cell crisis diagnosis code

• Postpartum hemorrhage diagnosis code

PLEASE SEE CDC-AIM SMM APPENDIX ON WSHA WEBSITE FOR DETAILED LIST OF SEVERE MATERNAL MORBIDITY ICD-CODES FOR BOTH NUMERATOR AND DENOMINATOR.


# Outcome Measure



Definition Source


13 Severe Maternal Morbidity among delivering women with a diagnosis of pre-eclampsia, or superimposed preeclampsia

Among the denominator, all cases with any Severe Maternal Morbidity Code (see CDC-AIM SMM Appendix).

All mothers during their birth admission, excluding ectopics and miscarriages, with one of the following diagnosis codes:

• Severe Preeclampsia

• Eclampsia

• Preeclampsia superimposed on pre-existing hypertension



Among the denominator, number of women with Severe Maternal Morbidity (based on ICD-10 diagnosis-procedure codes): Diagnosis Codes for:





• Aneurysm

• Cardiac Arrest


• Eclampsia



• Pulmonary Edema


• Sepsis

• Shock




• Transfusion


• Hysterectomy


• Ventilation







• 775 Vaginal del w/o cc OR ICD-10-CM Delivery codes (see Appendix) AND Any code for:

• Severe Preeclampsia

• Eclampsia

• Preeclampsia superimposed on pre-existing hypertension

PLEASE SEE CDC-AIM SMM APPENDIX ON WSHA WEBSITE FOR DETAILED LIST OF SEVERE MATERNAL MORBIDITY ICD-CODES FOR BOTH NUMERATOR AND DENOMINATOR.

14 Maternal Chorioamnionitis or newborn affected by

Maternal Chorio-amnionitis

All inborn newborns linked to


Patient Discharge Data and

PLEASE SEE APPENDIX Include: All inborn newborns linked with maternal delivery, record.


# Outcome Measure



Definition Source


chorioamnionitis among inborn newborns (two subgroups: a) from Primary TSV deliveries and b) from Non-Primary TSV deliveries)

and/or newborn affected by chorio-amnionitis from among the denominator.

delivering mother’s record (two subgroups: a) from Primary TSV >= 37 weeks without prior cesarean delivery and b) from Non-Primary TSV delivery).

linked Maternal / Newborn records Plus Gestational age at Delivery From either: Core Clinical Maternal data OR Birth Certificate data. When birth certificate data available add to exclusions: Previous c-section (# 57.7 on Birth Certificate).

PLEASE SEE APPENDIX CHORIOAMNIONITIS AND SHOULDER DYSTOCIA WITH NEWBORN BIRTH INJURY SPECIFICATIONS ON WSHA WEBSITE for detailed list of ICD-9-CM and ICD-10-CM codes FOR BOTH NUMERATOR AND DENOMINATOR. MEASURE CALCULATED FOR TWO DENOMINATOR SUBGROUPS:

A) PRIMARY TSV DELIVERIES WITHOUT HISTORY OF PRIOR CESAREAN (SEE MEASURE #2 DEFINITION)

B) NON-PRIMARY TSV DELIVERIES (ALL DELIVERIES THAT WERE NOT AMONG SUBGROUP A

FOR SUBGROUP A) PRIMARY TSV DELIVERIES: Exclude cases with:

• Gestational Age < 37 weeks at delivery

• Any listed ICD-10-CM diagnosis code for contraindication to vaginal delivery: abnormal presentation, breech, preterm, fetal death, or multiple gestation (see Appendix for detail on ICD-10 codes)

• Any listed ICD-10-CM diagnosis code for Previous Cesarean delivery (034.21 Maternal care for scar from previous cesarean delivery)

SEE TWO APPENDIX DOCUMENTS ON WSHA WEBSITE FOR PRIMARY TERM SINGLETON VERTEX CESAREAN RATE FOR COMPLETE LIST OF CODES. FOR SUBGROUP B) NON-PRIMARY TSV DELIVERIES: All deliveries excluding those that were among Subgroup A (Primary TSV Deliveries).

15 Newborn with Severe Complication among term inborn newborns with

From among the denominator, newborns with

All term inborns linked with maternal delivery record


Patient Discharge Data Plus

PLEASE SEE APPENDIX Include: All inborn newborns linked with maternal delivery, record. Inborn Newborn diagnoses codes:


# Outcome Measure



Definition Source


shoulder dystocia delivery

brachial plexus, other injury, hypoxia/ asphyxia, low 5" Apgar < 7 or death.

who had a shoulder dystocia with delivery (GA >= 37 weeks or newborn BW >= 2000g).

linked mother-baby records, Plus 5 min Apgar, birth weight, and Gestational age at delivery from either: Core Clinical Maternal and Newborn data OR birth certificate data.

PLEASE SEE APPENDIX FOR CHORIOAMNIONITIS AND SHOULDER DYSTOCIA WITH NEWBORN SEVERE COMPLICATIONS SPECIFICATIONS ON WSHA WEBSITE for detailed list of ICD-9-CM and ICD-10-CM codes.

RETIRED Measures:

4b Number of maternal ICU DAYS per 100 deliveries (RETIRED)

Number of ICU days among the denominator.

Women with delivery at any gestational age, calculated per 100 delivering women.


Patient Discharge Data including Billing Revenue Code data (for ICU stay).

Among the denominator number of maternal ICU days as identified by either: Number of unit charge codes associated with Revenue code in Accommodations 0200 series (ICU) from PDD OR Number of ICU days from Maternal Supplemental Clinical Data OR OPTIONAL chart review via: WSHA-CMDC: secure chart review web interface OR WSHA-QBS: other hospital chart review source. Calculated per 100 Discharges among the denominator.

Include all delivering women identified by DRG, MS-DRG or ICD-10 codes below: DRG Codes:







OR MS-DRG codes:






• 775 Vaginal del w/o cc OR


# Outcome Measure



Definition Source


Delivery ICD-10 codes: Joint Commission Appendix A: Table 11.01.1.

9c Rate of severe maternal morbidity for Delivering women with a diagnosis of Pre-eclampsia, Severe Morbidity based on ICD-10 codes (RETIRED)

Total number of women with Severe Maternal Morbidity from patients among the denominator.

All delivering women with any diagnosis code for Preeclampsia.

CMQCC Preeclampsia Collaborative Measure.


Among the denominator number of women with Severe Maternal Morbidity (based on ICD-10 diagnosis-procedure codes): Diagnosis Codes:


• Pulmonary Edema

• Adult Respiratory Distress Syndrome

• Puerperal Cerebrovascular Disorder

• Disseminated Intravascular Coagulation Syndrome

• Postpartum Hemorrhage

• Abruptio Placentae OR Procedure Codes:

• Ventilation

• Transfusion

Include all delivering women identified by DRG, MS-DRG, or ICD-10-CM codes below: Delivery DRG Codes:







OR MS-DRG codes:






• 775 Vaginal del w/o cc OR ICD-10-CM codes: Joint Commission Appendix A: Table 11.01.1. AND with any diagnosis code for Preeclampsia, Severe preeclampsia, Eclampsia, or preeclampsia superimposed on pre-existing HTN:

• 014.00 Mild to moderate pre-eclampsia, unspecified trimester

• 014.02 Mild to moderate pre-eclampsia, second trimester

• 014.03 Mild to moderate pre-eclampsia, third trimester

• 014.90 Unspecified pre-eclampsia, unspecified trimester

• 014.92 Unspecified pre-eclampsia, second trimester


# Outcome Measure



Definition Source


• 014.93 Unspecified pre-eclampsia, third trimester

• 011.1 Pre-existing hypertension with pre-eclampsia, first trimester

• 011.2 Pre-existing hypertension with pre-eclampsia, second trimester

• 011.3 Pre-existing hypertension with pre-eclampsia, third trimester

• 011.9 Pre-existing hypertension with pre-eclampsia, unspecified trimester

• 014.10 Severe pre-eclampsia, unspecified trimester

• 014.12 Severe pre-eclampsia, second trimester

• 014.13 Severe pre-eclampsia, third trimester

• 014.20 HELLP syndrome, unspecified trimester

• 014.22 HELLP syndrome, second trimester

• 014.23 HELLP syndrome, third trimester

• 015.00 Eclampsia in pregnancy, unspecified trimester

• 015.02 Eclampsia in pregnancy, second trimester

• 015.03 Eclampsia in pregnancy, third trimester

• 015.1 Eclampsia in labor

• 015.2 Eclampsia in the puerperium

• 015.9 Eclampsia, unspecified as to time period

Note for Measures 3.a., 3.b., 4.a., 4.b., 5.a., 5.b., 5.c., 8, 9, 11, 12, 13: These measures are intended for collaborative and similar QI projects that utilize time series designs (same hospital before and after). These are not designed or validated to be used as inter-hospital quality measures (comparing hospital A to B or to compare practices of individual clinicians). These are metrics that will need some case mix/risk adjustment with validation work before any comparisons between hospitals can be done, but they are valuable to hospitals in trending their own data.


Numerator Specifications for Measure 5a and 5d: women who received a blood transfusion.

List of ICD-10 Procedure code for specific transfusions:

30233H1 Transfusion of Nonautologous Whole Blood into Peripheral Vein, Percutaneous Approach

30233N0 Transfusion of Autologous Red Blood Cells into Peripheral Vein, Percutaneous Approach

30233N1 Transfusion of Nonautologous Red Blood Cells into Peripheral Vein, Percutaneous Approach

30233P0 Transfusion of Autologous Frozen Plasma into Peripheral Vein, Percutaneous Approach

30233P1 Transfusion of Nonautologous Frozen Plasma into Peripheral Vein, Percutaneous Approach

30233T1 Transfusion of Nonautologous Fibrinogen into Peripheral Vein, Percutaneous Approach

30240H1 Transfusion of Nonautologous Whole Blood into Central Vein, Open Approach

30243H1 Transfusion of Nonautologous Whole Blood into Central Vein, Percutaneous Approach

30240K1 Transfusion of Nonautologous Frozen Plasma into Central Vein, Open Approach

30240L1 Transfusion of Nonautologous Fresh Plasma into Central Vein, Open Approach

30240M1 Transfusion of Nonautologous Plasma Cryoprecipitate into Central Vein, Open Approach

30243N0 Transfusion of Autologous Red Blood Cells into Central Vein, Percutaneous Approach

30243N1 Transfusion of Nonautologous Red Blood Cells into Central Vein, Open Approach

30243P0 Transfusion of Autologous Frozen Red Cells into Central Vein, Percutaneous Approach

30243P1 Transfusion of Nonautologous Frozen Red Cells into Central Vein, Percutaneous Approach

30243R1 Transfusion of Nonautologous Platelets into Central Vein, Open Approach

30243T1 Transfusion of Nonautologous Fibrinogen into Central Vein, Percutaneous Approach

30253H1 Transfusion of Nonautologous Whole Blood into Peripheral Artery, Percutaneous Approach

30253N1 Transfusion of Nonautologous Red Blood Cells into Peripheral Artery, Percutaneous Approach

30253P1 Transfusion of Nonautologous Frozen Plasma into Peripheral Artery, Percutaneous Approach

30263H1 Transfusion of Nonautologous Whole Blood into Central Artery, Percutaneous Approach

30263N1 Transfusion of Nonautologous Red Blood Cells into Central Artery, Percutaneous Approach

30263P1 Transfusion of Nonautologous Frozen Plasma into Central Artery, Percutaneous Approach


30233K1 Transfusion of Nonautologous Frozen Plasma into Peripheral Vein, Percutaneous Approach

30233L1 Transfusion of Nonautologous Fresh Plasma into Peripheral Vein, Percutaneous Approach

30243K1 Transfusion of Nonautologous Frozen Plasma into Central Vein, Percutaneous Approach

30243L1 Transfusion of Nonautologous Fresh Plasma into Central Vein, Percutaneous Approach

30253K1 Transfusion of Nonautologous Frozen Plasma into Peripheral Artery, Percutaneous Approach

30253L1 Transfusion of Nonautologous Fresh Plasma into Peripheral Artery, Percutaneous Approach

30263K1 Transfusion of Nonautologous Frozen Plasma into Central Artery, Percutaneous Approach

30263L1 Transfusion of Nonautologous Fresh Plasma into Central Artery, Percutaneous Approach

30233M1 Transfusion of Nonautologous Plasma Cryoprecipitate into Peripheral Vein, Percutaneous Approach

30233R1 Transfusion of Nonautologous Platelets into Peripheral Vein, Percutaneous Approach

30243M1 Transfusion of Nonautologous Plasma Cryoprecipitate into Central Vein, Percutaneous Approach

30243R1 Transfusion of Nonautologous Platelets into Central Vein, Percutaneous Approach

30253M1 Transfusion of Nonautologous Plasma Cryoprecipitate into Peripheral Artery, Percutaneous Approach

30253R1 Transfusion of Nonautologous Platelets into Peripheral Artery, Percutaneous Approach

30263M1 Transfusion of Nonautologous Plasma Cryoprecipitate into Central Artery, Percutaneous Approach

30263R1 Transfusion of Nonautologous Platelets into Central Artery, Percutaneous Approach

Base Deliveries Code Specifications ICD-10 Diagnoses

Z37.0 Single live birth

Z37.1 Single stillbirth

Z37.2 Twins, both liveborn

Z37.3 Twins, one liveborn and one stillborn

Z37.4 Twins, both stillborn

Z37.50 Multiple births, unspecified, all liveborn

Z37.51 Triplets, all liveborn


Z37.52 Quadruplets, all liveborn

Z37.53 Quintuplets, all liveborn

Z37.54 Sextuplets, all liveborn

Z37.59 Other multiple births, all liveborn

Z37.60 Multiple births, unspecified, some liveborn

Z37.61 Triplets, some liveborn

Z37.62 Quadruplets, some liveborn

Z37.63 Quintuplets, some liveborn

Z37.64 Sextuplets, some liveborn

Z37.69 Other multiple births, some liveborn

Z37.7 Other multiple births, all stillborn

Z37.9 Outcome of delivery, unspecified

O80 Encounter for full-term uncomplicated delivery

O82 Encounter for cesarean delivery without indication

ICD-10 Procedures

10D00Z0 Extraction of Products of Conception, Classical, Open Approach

10D00Z1 Extraction of Products of Conception, Low Cervical, Open Approach

10D00Z2 Extraction of Products of Conception, Extraperitoneal, Open Approach

10D07Z3 Extraction of Products of Conception, Low Forceps, Via Natural or Artificial Opening

10D07Z4 Extraction of Products of Conception, Mid Forceps, Via Natural or Artificial Opening

10D07Z5 Extraction of Products of Conception, High Forceps, Via Natural or Artificial Opening

10D07Z6 Extraction of Products of Conception, Vacuum, Via Natural or Artificial Opening

10D07Z7 Extraction of Products of Conception, Internal Version, Via Natural or Artificial Opening

10D07Z8 Extraction of Products of Conception, Other, Via Natural or Artificial Opening

10E0XZZ Delivery of Products of Conception, External Approach

Then Exclude deliveries with these codes (e.g. miscarriages, ectopics)

ICD-10 Diagnoses

O00.0 Abdominal pregnancy

O00.00 Abdominal pregnancy without intrauterine pregnancy

O00.01 Abdominal pregnancy with intrauterine pregnancy

O00.1 Tubal pregnancy

O00.10 Tubal pregnancy without intrauterine pregnancy

O00.101 Right tubal pregnancy without intrauterine pregnancy

O00.102 Left tubal pregnancy without intrauterine pregnancy


O00.109 Unspecified tubal pregnancy without intrauterine pregnancy

O00.11 Tubal pregnancy with intrauterine pregnancy

O00.111 Right tubal pregnancy with intrauterine pregnancy

O00.112 Left tubal pregnancy with intrauterine pregnancy

O00.119 Unspecified tubal pregnancy with intrauterine pregnancy

O00.2 Ovarian pregnancy

O00.20 Ovarian pregnancy without intrauterine pregnancy

O00.201 Right ovarian pregnancy without intrauterine pregnancy

O00.202 Left ovarian pregnancy without intrauterine pregnancy

O00.209 Unspecified ovarian pregnancy without intrauterine pregnancy

O00.21 Ovarian pregnancy with intrauterine pregnancy

O00.211 Right ovarian pregnancy with intrauterine pregnancy

O00.212 Left ovarian pregnancy without intrauterine pregnancy

O00.219 Unspecified ovarian pregnancy with intrauterine pregnancy

O00.8 Other ectopic pregnancy

O00.80 Other ectopic pregnancy without intrauterine pregnancy

O00.81 Other ectopic pregnancy with intrauterine pregnancy

O00.9 Ectopic pregnancy, unspecified

O00.90 Unspecified ectopic pregnancy without intrauterine pregnancy

O00.91 Unspecified ectopic pregnancy with intrauterine pregnancy

O01.0 Classical hydatidiform mole

O01.1 Incomplete and partial hydatidiform mole

O01.9 Hydatidiform mole, unspecified

O02.0 Blighted ovum and nonhydatidiform mole

O02.1 Missed abortion

O02.81 Inappropriate change in quantitative human chorionic gonadotropin (hCG) in early pregnancy

O02.89 Other abnormal products of conception

O02.9 Abnormal product of conception, unspecified

O03.0 Genital tract and pelvic infection following incomplete spontaneous abortion

O03.1 Delayed or excessive hemorrhage following incomplete spontaneous abortion

O03.2 Embolism following incomplete spontaneous abortion

O03.30 Unspecified complication following incomplete spontaneous abortion

O03.31 Shock following incomplete spontaneous abortion

O03.32 Renal failure following incomplete spontaneous abortion

O03.33 Metabolic disorder following incomplete spontaneous abortion


O03.34 Damage to pelvic organs following incomplete spontaneous abortion

O03.35 Other venous complications following incomplete spontaneous abortion

O03.36 Cardiac arrest following incomplete spontaneous abortion

O03.37 Sepsis following incomplete spontaneous abortion

O03.38 Urinary tract infection following incomplete spontaneous abortion

O03.39 Incomplete spontaneous abortion with other complications

O03.4 Incomplete spontaneous abortion without complication

O03.5 Genital tract and pelvic infection following complete or unspecified spontaneous abortion

O03.6 Delayed or excessive hemorrhage following complete or unspecified spontaneous abortion

O03.7 Embolism following complete or unspecified spontaneous abortion

O03.80 Unspecified complication following complete or unspecified spontaneous abortion

O03.81 Shock following complete or unspecified spontaneous abortion

O03.82 Renal failure following complete or unspecified spontaneous abortion

O03.83 Metabolic disorder following complete or unspecified spontaneous abortion

O03.84 Damage to pelvic organs following complete or unspecified spontaneous abortion

O03.85 Other venous complications following complete or unspecified spontaneous abortion

O03.86 Cardiac arrest following complete or unspecified spontaneous abortion

O03.87 Sepsis following complete or unspecified spontaneous abortion

O03.88 Urinary tract infection following complete or unspecified spontaneous abortion

O03.89 Complete or unspecified spontaneous abortion with other complications

O03.9 Complete or unspecified spontaneous abortion without complication

O04.5 Genital tract and pelvic infection following (induced) termination of pregnancy

O04.6 Delayed or excessive hemorrhage following (induced) termination of pregnancy

O04.7 Embolism following (induced) termination of pregnancy

O04.80 (Induced) termination of pregnancy with unspecified complications

O04.81 Shock following (induced) termination of pregnancy

O04.82 Renal failure following (induced) termination of pregnancy

O04.83 Metabolic disorder following (induced) termination of pregnancy

O04.84 Damage to pelvic organs following (induced) termination of pregnancy

O04.85 Other venous complications following (induced) termination of pregnancy

O04.86 Cardiac arrest following (induced) termination of pregnancy

O04.87 Sepsis following (induced) termination of pregnancy

O04.88 Urinary tract infection following (induced) termination of pregnancy

O04.89 (Induced) termination of pregnancy with other complications

O07.0 Genital tract and pelvic infection following failed attempted termination of pregnancy


O07.1 Delayed or excessive hemorrhage following failed attempted termination of pregnancy

O07.2 Embolism following failed attempted termination of pregnancy

O07.30 Failed attempted termination of pregnancy with unspecified complications

O07.31 Shock following failed attempted termination of pregnancy

O07.32 Renal failure following failed attempted termination of pregnancy

O07.33 Metabolic disorder following failed attempted termination of pregnancy

O07.34 Damage to pelvic organs following failed attempted termination of pregnancy

O07.35 Other venous complications following failed attempted termination of pregnancy

O07.36 Cardiac arrest following failed attempted termination of pregnancy

O07.37 Sepsis following failed attempted termination of pregnancy

O07.38 Urinary tract infection following failed attempted termination of pregnancy

O07.39 Failed attempted termination of pregnancy with other complications

O07.4 Failed attempted termination of pregnancy without complication

O08.0 Genital tract and pelvic infection following ectopic and molar pregnancy

O08.1 Delayed or excessive hemorrhage following ectopic and molar pregnancy

O08.2 Embolism following ectopic and molar pregnancy

O08.3 Shock following ectopic and molar pregnancy

O08.4 Renal failure following ectopic and molar pregnancy

O08.5 Metabolic disorders following an ectopic and molar pregnancy

O08.6 Damage to pelvic organs and tissues following an ectopic and molar pregnancy

O08.7 Other venous complications following an ectopic and molar pregnancy

O08.81 Cardiac arrest following an ectopic and molar pregnancy

O08.82 Sepsis following ectopic and molar pregnancy

O08.83 Urinary tract infection following an ectopic and molar pregnancy

O08.89 Other complications following an ectopic and molar pregnancy

O08.9 Unspecified complication following an ectopic and molar pregnancy

Z39.0 Encounter for care and examination of mother immediately after delivery

Z39.1 Encounter for care and examination of lactating mother

Z39.2 Encounter for routine postpartum follow-up

ICD-10 Procedures

10A00ZZ Abortion of Products of Conception, Open Approach

10A03ZZ Abortion of Products of Conception, Percutaneous Approach

10A04ZZ Abortion of Products of Conception, Percutaneous Endoscopic Approach

10A07Z6 Abortion of Products of Conception, Vacuum, Via Natural or Artificial Opening

10A07ZW Abortion of Products of Conception, Laminaria, Via Natural or Artificial Opening


10A07ZX Abortion of Products of Conception, Abortifacient, Via Natural or Artificial Opening

10A07ZZ Abortion of Products of Conception, Via Natural or Artificial Opening

10A08ZZ Abortion of Products of Conception, Via Natural or Artificial Opening Endoscopic

Postpartum Hemorrhage Code Specifications

IC0-10 Code ICD-10 Description

Diagnosis Codes

O72.0 Third-stage hemorrhage

O72.1 Other immediate postpartum hemorrhage

O72.2 Delayed and secondary postpartum hemorrhage

O72.3 Postpartum coagulation defects

Third-stage hemorrhage (O72.0) and with any of the following placenta accreta, increta, or percreta codes

O43.211 Placenta accreta, first trimester or

O43.212 Placenta accreta, second trimester or

O43.213 Placenta accreta, third trimester or

O43.221 Placenta increta, first trimester or

O43.222 Placenta increta, second trimester or

O43.223 Placenta increta, third trimester or

O43.231 Placenta percreta, first trimester or

O43.232 Placenta percreta, second trimester or

O43.233 Placenta percreta third trimester

Procedure Codes

Hemorrhage Repair

0W3F0ZZ Control Bleeding in Abdominal Wall, Open Approach

0W3F3ZZ Control Bleeding in Abdominal Wall, Percutaneous Approach

0W3F4ZZ Control Bleeding in Abdominal Wall, Percutaneous Endoscopic Approach

0W3G3ZZ Control Bleeding in Peritoneal Cavity, Percutaneous Approach


0W3G4ZZ Control Bleeding in Peritoneal Cavity, Percutaneous Endoscopic Approach

0W3H3ZZ Control Bleeding in Retroperitoneum, Percutaneous Approach

0W3H4ZZ Control Bleeding in Retroperitoneum, Percutaneous Endoscopic Approach

0W3J0ZZ Control Bleeding in Pelvic Cavity, Open Approach

0W3J3ZZ Control Bleeding in Pelvic Cavity, Percutaneous Approach

0W3J4ZZ Control Bleeding in Pelvic Cavity, Percutaneous Endoscopic Approach

0W3K0ZZ Control Bleeding in Upper Back, Open Approach

0W3K3ZZ Control Bleeding in Upper Back, Percutaneous Approach

0W3K4ZZ Control Bleeding in Upper Back, Percutaneous Endoscopic Approach

0W3N0ZZ Control Bleeding in Female Perineum, Open Approach

0W3N3ZZ Control Bleeding in Female Perineum, Percutaneous Approach

0W3N4ZZ Control Bleeding in Female Perineum, Percutaneous Endoscopic Approach

0W3P3ZZ Control Bleeding in Gastrointestinal Tract, Percutaneous Approach

0W3P4ZZ Control Bleeding in Gastrointestinal Tract, Percutaneous Endoscopic Approach

0W3R0ZZ Control Bleeding in Genitourinary Tract, Open Approach

0W3R3ZZ Control Bleeding in Genitourinary Tract, Percutaneous Approach

0W3R4ZZ Control Bleeding in Genitourinary Tract, Percutaneous Endoscopic Approach

0W3R7ZZ Control Bleeding in Genitourinary Tract, Via Natural or Artificial Opening

0W3R8ZZ Control Bleeding in Genitourinary Tract, Via Natural or Artificial Opening Endoscopic

0Y300ZZ Control Bleeding in Right Buttock, Open Approach

0Y303ZZ Control Bleeding in Right Buttock, Percutaneous Approach

0Y304ZZ Control Bleeding in Right Buttock, Percutaneous Endoscopic Approach

0Y310ZZ Control Bleeding in Left Buttock, Open Approach

0Y313ZZ Control Bleeding in Left Buttock, Percutaneous Approach

0Y314ZZ Control Bleeding in Left Buttock, Percutaneous Endoscopic Approach

0Y350ZZ Control Bleeding in Right Inguinal Region, Open Approach

0Y353ZZ Control Bleeding in Right Inguinal Region, Percutaneous Approach

0Y354ZZ Control Bleeding in Right Inguinal Region, Percutaneous Endoscopic Approach

0Y360ZZ Control Bleeding in Left Inguinal Region, Open Approach

0Y363ZZ Control Bleeding in Left Inguinal Region, Percutaneous Approach

0Y364ZZ Control Bleeding in Left Inguinal Region, Percutaneous Endoscopic Approach

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