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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
255 0000 Process Yes Effective Clinical Care Claims

Measure Description

Percentage of Rh-negative pregnant women aged 14-50 years at risk of fetal blood exposure who receive Rh-Immunoglobulin (Rhogam) in the emergency department (ED)

Instructions

This measure is to be submitted each time a pregnant patient presents to the emergency department with complaints including blunt abdominal trauma, vaginal bleeding, ectopic pregnancy, and threatened or spontaneous abortion.

Claims data will be analyzed to determine the emergency department discharge. Patients who present to the emergency department with these complaints should have documentation in the medical record of receiving an order for Rh-Immunoglobulin (Rhogam). It is anticipated that eligible clinicians who provide care in the emergency department will submit this measure. The Part B claim form place of service field must indicate that the encounter has taken place in the emergency department.

NOTE: No notes related

Measure Submission

The listed denominator criteria is used to identify the intended patient population. The numerator quality-data codes included in this specification are used to submit the quality actions allowed by the measure. All measure-specific coding should be submitted on the claim(s) representing the eligible encounter.

NUMERATOR

Patients who receive an order for Rh-Immunoglobulin (Rhogam) in the ED

Definition

Numerator Instructions: This measure is to be submitted each time a patient meets the requirements as indicated in the denominator. In the clinical event a patient has documented receipt of Rhogam submit quality data code G8810.

Numerator Quality-Data Coding Options

NUMERATOR 

Denominator Exception: G8810:
Rh-immunoglobulin (Rhogam) not Ordered for Documented Reasons

Rh-immunoglobulin (Rhogam) not ordered for reasons documented by clinician (e.g., patient had prior documented receipt of Rhogam within 12 weeks, patient refusal)

NUMERATOR 

Performance Met: G8809:
Documentation in Medical Record that Rh-immunoglobulin (Rhogam) Ordered

 

Rh-immunoglobulin (Rhogam) ordered

NUMERATOR:

Performance Not Met: G8811:
Rh-immunoglobulin (Rhogam) not Ordered, Reason not Given:

 

Trans-abdominal or trans-vaginal ultrasound not performed, reason not given

Numerator Note: No data

Denominator

All pregnant female patients aged 14 to 50 years who are Rh-negative and at significant risk of fetal blood exposure

Eligible cases are determined and must be reported, if either of the following conditions

Option 1 – Denominator Criteria (Eligible Cases):

Female patients aged 14 to 50 years on date of encounter

AND

Diagnosis for Rh-Negative (ICD-10-CM): O36.0110, O36.0111, O36.0190, O36.0191, O36.0910, O36.0911,
O36.0990, O36.0991

AND

Diagnosis of High Risk Pregnancy Complications (ICD-10-CM): , O00.80, O00.81, O00.90, O00.91, O02.1,
O03.1, O03.6, O04.6, O07.1, O08.1, O20.0, O20.8, O20.9, O26.891, O43.011, O43.019, O44.30, O44.50,
O44.31, O44.51, O45.001, O45.009, O45.011, O45.019, O45.021, O45.029, O45.091, O45.099, O45.8X1,
O45.8X9, O45.90, O45.91, O46.001, O46.011, O46.021, O46.8X1, O46.8X9, O46.90, O46.91

AND

Patient encounter during the performance period (CPT): 99281, 99282, 99283, 99284, 99285, 99291

AND

Place of Service Indicator: 23
(The Part B claim form Place of Service field must indicate emergency department)

 

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