Maternity Care Primary C-Section Rate Specifications
2014 (07/01/2013 to 06/30/2014 Dates of Service)
Summary of
Changes
Denominator Changes:
Two additions were made to the denominator criteria. The denominator was
changed to include patients who had:
 a vertex position delivery AND
 a term pregnancy of greater or equal to 37 weeks gestation
Please review the denominator section to review all criteria.
Eligible Clinics:
Any clinic that is part of a medical group in which the medical group has
providers who perform cesarean deliveries will be eligible to report data for
this measure.
Description
A measure of the percentage of cesarean deliveries for nulliparous births.
Methodology
Population identification is accomplished via a query of a practice management
system or Electronic Medical Record (EMR) to identify the population of eligible
patients (denominator). Data elements are either extracted from an EMR
system or abstracted through medical record review.
Full population data is required.
Rationale
Safe and healthy pregnancies and births are a primary goal for society and
particularly for expectant mothers and their families, healthcare providers, and
payers. While most births are positive experiences with healthy outcomes,
childbirth also brings substantial risks for both the mother and the infant.
For consumers, Minnesota lacks publicly reported maternity measures to aid
and inform decision making. Several other states have public reporting for
maternity care measures, most commonly cesarean section (C-section) and
vaginal birth after C-section delivery (VBAC) rates due to the high volume, high
costs and increased morbidity associated with C-section procedures.
Recently, new clinical guidelines offering more direction regarding the care and
management of pregnant women and childbirth have been released along with
new quality measures that can be used to highlight variation and underscore
appropriate maternal care.
Measurement
Period
Measurement period will be a fixed 12-month period: 07/01/2013 to 06/30/2014.
Denominator
Patients who meet each of the following criteria is included in the measure
denominator:
 Female patient was nulliparous and of any age.
 Patient had a single liveborn delivery.
 Patient had vertex position delivery of a term (greater or equal to 37
weeks gestation) baby via a vaginal or cesarean birth.
 Patient had at least one prenatal care visit with an eligible provider in an
eligible specialty in the medical group prior to the onset of labor.
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Maternity Care Primary C-Section Rate Specifications
2014 (07/01/2013 to 06/30/2014 Dates of Service)

Patient was delivered by an eligible provider in an eligible specialty who
had a delivery date during the measurement period (07/01/2013 to
06/30/2014).
Eligible clinics: All clinics that are part of a medical group in which the medical
group has providers who perform cesarean section procedures.
Eligible specialties: Family Medicine, General Practice, Obstetrics/Gynecology,
Perinatology.
Eligible providers: Medical Doctor (MD), Doctor of Osteopathy (DO), Certified
Nurse Midwives (CMS), and Certified Professional Midwives (CPM).
Recommendations to identify nulliparous, singleton, liveborn deliveries:
1. Nulliparous female patients:
Nulliparous women are defined as women whose pregnancy is at least
at 20 weeks gestational age and who have not previously had a
pregnancy of at least 20 weeks gestational age in the past. Medical
groups / clinics will need to track and supply information about nulliparity
either through medical codes or in the medical record. Identification of
nulliparous deliveries can be accomplished by using one of the following
suggested methods:
a. Create a field in an electronic medical record or chart to indicate
nulliparity.
b. ICD-9 codes that medical groups / clinics may use to identify
nulliparous women if used consistently for all deliveries (see
Table 1). Those ICD-9 codes are:
 V22.0 Supervision of normal first pregnancy.
 V23.81 Other high-risk pregnancy; Elderly primigravida.
 V23.83 Other high-risk pregnancy: Young primigravida.
c. Use the enumeration of a female’s obstetrical history where
parity (P) = 0 (zero).
2. Singleton liveborn deliveries:
Defined as a delivery with one liveborn baby. Identification of singleton
liveborn deliveries can be accomplished by using one of the following
suggested methods:
a. ICD-9 code V27.0 (single liveborn; see Table 2).
b. Create a field in an electronic medical record or chart to indicate
single, liveborn.
3. Identification of deliveries and type of delivery:
Type of delivery defined as vaginal or cesarean section delivery.
Identification of type of delivery can be accomplished by using one of the
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Maternity Care Primary C-Section Rate Specifications
2014 (07/01/2013 to 06/30/2014 Dates of Service)
following suggested methods:
a. CPT procedure codes (see Table 3):
 59400 routine care with vaginal delivery.
 59409 vaginal delivery only.
 59410 vaginal delivery only including postpartum care.
 59510 routine care with cesarean delivery.
 59514 cesarean delivery only.
 59515 cesarean delivery only including postpartum care.
b. Create a field in an electronic medical record or chart that
indicates type of delivery.
c. Select ICD-9 codes indicating that a delivery occurred. Please
refer to the data collection guide for a list of suggested codes to
be used to identify patients.
Exclusions



Numerator
Patient had pregnancy with multiple gestations (ICD-9 codes 651.00651.93, V27.2-V27.7; see Table 4).
Patient had pregnancy with a stillborn (ICD-9 codes 656.40-656.43,
V27.1; see Table 4).
Patient had delivery with a non-vertex fetal position (ICD-9 codes
652.20-652.43, 652.80-6520.83, 669.60; see Table 5).
The number of live, singleton, vertex position, term (greater or equal to 37
weeks gestation) newborns who were delivered via cesarean section.
When no prenatal care is provided by the medical group/clinic, the C-section
delivery is not included in the numerator calculation for the C-section rate.
(Additional instructions on how to identify and provide this information are in the
data collection guide.)
Codes Used to Identify Patients who Meet Inclusion Criteria
Please use the tables below and the tables located in the Data Collection Guide Appendices to identify
patients who meet inclusion criteria.
Table 1: ICD-9 Diagnosis Codes for Identifying Nulliparity
ICD-9 Diagnosis
Code
ICD-9 Diagnosis Code Description
V22.0
Supervision of normal first pregnancy
V23.81
Other high-risk pregnancy; Elderly primigravida
V23.83
Other high-risk pregnancy: Young primigravida
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Maternity Care Primary C-Section Rate Specifications
2014 (07/01/2013 to 06/30/2014 Dates of Service)
Table 2: ICD-9 Diagnosis Codes for Identifying Single Liveborn
ICD-9 Diagnosis
Code
ICD-9 Diagnosis Code Description
V27.0
Single liveborn
Table 3: CPT Procedure Codes for Identifying Deliveries and Delivery Type
CPT Procedure
Code
CPT Procedure Code Description
59400
Routine care with vaginal delivery
59409
Vaginal delivery only
59410
Vaginal delivery only including postpartum care
59510
Routine care with cesarean delivery
59514
Cesarean delivery only
59515
Cesarean delivery only including postpartum care
Codes Used to Identify Patients who Meet Exclusion Criteria
Table 4: ICD-9 Diagnosis Codes for Identifying Stillborn and Multiple Gestation Births
ICD-9 Diagnosis
Code
ICD-9 Diagnosis Code Description
V27.1
Outcome of delivery, single stillborn
V27.2
Outcome of delivery, twins, both liveborn
V27.3
Outcome of delivery, twins, one liveborn and one stillborn
V27.4
Outcome of delivery, twins, both stillborn
V27.5
Outcome of delivery, other multiple birth, all liveborn
V27.6
Outcome of delivery, other multiple birth, some liveborn
V27.7
Outcome of delivery, other multiple birth, all stillborn
651.00
Twin pregnancy, unspecified as to episode of care or not applicable
651.01
Twin pregnancy, delivered, with or without mention of antepartum condition
651.03
Twin pregnancy, antepartum condition or complication
651.10
Triplet pregnancy, unspecified as to episode of care or not applicable
651.11
Triplet pregnancy, delivered, with or without mention of antepartum condition
651.13
Triplet pregnancy, antepartum condition or complication
651.20
Quadruplet pregnancy, unspecified as to episode of care or not applicable
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Maternity Care Primary C-Section Rate Specifications
2014 (07/01/2013 to 06/30/2014 Dates of Service)
ICD-9 Diagnosis
Code
ICD-9 Diagnosis Code Description
651.21
Quadruplet pregnancy, delivered, with or without mention of antepartum
condition
651.23
Quadruplet pregnancy, antepartum condition or complication
651.30
Twin pregnancy with fetal loss and retention of one fetus, unspecified as to
episode of care or not applicable
651.31
Twin pregnancy with fetal loss and retention of one fetus, delivered, with or
without mention of antepartum condition
651.33
Twin pregnancy with fetal loss and retention of one fetus, antepartum condition
or complication
651.40
Triplet pregnancy with fetal loss and retention of one or more fetus(es),
unspecified as to episode of care or not applicable
651.41
Triplet pregnancy with fetal loss and retention of one or more fetus(es),
delivered, with or without mention of antepartum condition
651.43
Triplet pregnancy with fetal loss and retention of one or more fetus(es),
antepartum condition or complication
651.50
Quadruplet pregnancy with fetal loss and retention of one or more fetus(es),
unspecified as to episode of care or not applicable
651.51
Quadruplet pregnancy with fetal loss and retention of one or more fetus(es),
delivered, with or without mention of antepartum condition
651.53
Quadruplet pregnancy with fetal loss and retention of one or more fetus(es),
antepartum condition or complication
651.60
Other multiple pregnancy with fetal loss and retention of one or more fetus(es),
unspecified as to episode of care or not applicable
651.61
Other multiple pregnancy with fetal loss and retention of one or more fetus(es),
delivered, with or without mention of antepartum condition
651.63
Other multiple pregnancy with fetal loss and retention of one or more fetus(es),
antepartum condition or complication
651.70
Multiple gestation following (elective) fetal reduction, unspecified as to episode
of care or not applicable
651.71
Multiple gestation following (elective) fetal reduction, delivered, with or without
mention of antepartum condition
651.73
Multiple gestation following (elective) fetal reduction, antepartum condition or
complication
651.80
Other specified multiple gestation, unspecified as to episode of care or not
applicable
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Maternity Care Primary C-Section Rate Specifications
2014 (07/01/2013 to 06/30/2014 Dates of Service)
ICD-9 Diagnosis
Code
ICD-9 Diagnosis Code Description
651.81
Other specified multiple gestation, delivered, with or without mention of
antepartum condition
651.83
Other specified multiple gestation, antepartum condition or complication
651.90
Unspecified multiple gestation, unspecified as to episode of care or not
applicable
651.91
Unspecified multiple gestation, delivered, with or without mention of antepartum
condition
651.93
Unspecified multiple gestation, antepartum condition or complication
656.40
Intrauterine death, affecting management of mother, unspecified as to episode
of care or not applicable
656.41
Intrauterine death, affecting management of mother, delivered, with or without
mention of antepartum condition
656.43
Intrauterine death, affecting management of mother, antepartum condition or
complication
Table 5: ICD-9 Procedure Codes for Identifying Non-Vertex Fetal Positions
ICD-9 Diagnosis
Codes
ICD-9 Diagnosis Code Description
652.20
Breech presentation without mention of version; unspecified as to episode of
care or not applicable
652.21
Breech presentation without mention of version; delivered, with or within
mention of antepartum condition
652.23
Breech presentation without mention of version; antepartum condition or
complication
652.30
Transverse or oblique presentation; unspecified as to episode of care or not
applicable
652.31
Transverse or oblique presentation; delivered, with or within mention of
antepartum condition
652.33
Transverse or oblique presentation; antepartum condition or complication
652.40
Face or brow presentation; unspecified as to episode of care or not applicable
652.41
Face or brow presentation; delivered, with or within mention of antepartum
condition
652.43
Face or brow presentation; antepartum condition or complication
652.80
Other specified malposition or malpresentation; unspecified as to episode of
care or not applicable
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Maternity Care Primary C-Section Rate Specifications
2014 (07/01/2013 to 06/30/2014 Dates of Service)
ICD-9 Diagnosis
Codes
ICD-9 Diagnosis Code Description
652.81
Other specified malposition or malpresentation; delivered, with or within
mention of antepartum condition
652.83
Other specified malposition or malpresentation; antepartum condition or
complication
669.60
Breech extraction, without mention of indication
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