Obstetric Anesthesia Type

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Description

This collation will be used to determine if cases with predicted or actual CPT codes for labor epidurals, cesarean deliveries, or cesarean hysterectomies (01961, 01967, 01968, 19969, or 01963) are one of eight case types: labor epidural, cesarean delivery, labor epidural converted to cesarean delivery, cesarean hysterectomy, conversion (labor epidural portion), conversion (cesarean delivery portion), conversion (cesarean hysterectomy portion) or unable to determine. High variability in use of CPT codes and frequent mismatches between CPT codes and procedures performed necessitate this phenotype. This phenotype will be used to include or exclude cases from obstetric specific measures and other general measures.

Limitation

This phenotype is limited to cases with predicted or actual CPT codes 01961, 01967, 01968, 01969 or 01963. Errors in coding may prevent an obstetric case of interest to be missed by this phenotype. Further, this phenotype is unable to determine procedures outside of labor epidural, cesarean delivery, cesarean hysterectomy or labor epidural converted to cesarean delivery. Cases not designated at one of these obstetric case types will be labeled as 'unable to determine.' Cesarean hysterectomies done without specifying ‘hysterectomy’ (or related terms) in the procedure text will not be differentiated from cesarean deliveries or not picked up by this collation.

Data quality is limited to individual site documentation accuracy, completeness, and variable mapping, which is performed by each site, independently. MPOG, as the coordinating center, reviews data quality at each data upload and monthly via Data Diagnostics and Case Validation tools. This review, while thorough, may not contain all data elements relevant to this phenotype and thus should be carefully reviewed by the user.

Value Type

Categorical

Enumeration

Value	Value Code	Definition

Return Columns

Column Name	Data Type

Granularity

Logic

Note: If there are multiple notes with different times documented, the phenotype uses the first documented time.

Step I: Examine CPT codes

If case has actual or predicted CPT codes 01961, 01967, 01968, 01969, or 01963 proceed to Step II. If not, return value "No" and stop.

Step II: Determine if case should be included in phenotype

Evaluate if procedure text contains "XRT IMRT TX DELIVERY COMPLEX-KV IGRT W ANES” or "PROTON"
1. If yes, exclude case. Return value "No"
2. If no, continue to number 2
Evaluate if the procedure text includes "tubal", "ligation", OR "btl" without including "cesarean" (or other versions of cesarean) AND has predicted or actual CPT codes 00851 AND concept 50596 is the only OB concept on the case (see list of included OB concepts)
1. If yes, exclude case. Return value "No"
2. If no, continue to number 3
Evaluate if case includes Neonate Delivered (50358) between Anesthesia Start (50002) and Anesthesia End (50009)
1. If yes, include case and move to Step III
2. If no, evaluate if case procedure text includes any of the following, and does not include "resection", "wound", "methotrexate", or "scar"
  1. Included procedure texts
    1. Active labor
    2. Antepartum
    3. Ante
    4. Induction + n/a
    5. Assisted Delivery
    6. C sec
    7. C/s
    8. Cesarean
    9. Ces section
    10. Cesarean Delivery
    11. C-hyst
    12. CS
    13. Deliver
    14. Induction + no other words
    15. Delivery
    16. Induction + labor
    17. Induction + OB
    18. IOL
    19. Labor
    20. CLE
    21. PPROM
    22. TOLAC
    23. Primary Section
    24. OB + anethesia
  2. If yes, include case and move to Step III
  3. If no, evaluate if procedure text includes any of the following procedure texts AND has any of the following OB concepts between Anesthesia Start (50002) and Anesthesia End (50009)
    1. Conditional procedure text
      1. Active labor
      2. Evaluation
      3. Consult
      4. Salpingectomy
      5. Version
      6. Amnioreduction
      7. Ligation
      8. Btl
      9. Tubal
      10. Cerclage
      11. ECV
      12. Epidural
      13. L&D
      14. Blood patch
      15. Anesthesia consult
      16. Possible Cesarean Delivery
      17. Cesarean (or derivatives) + Cephalic
      18. Cesarean (or derivatives) + Scar
      19. Cesarean (or derivatives) + Wound
      20. Cesarean (or derivatives) + Methotrexate
      21. Delivery + Placenta
      22. Analgesia
      23. D&C
      24. Observation
      25. Ovarian
      26. Obs
      27. Hyster
      28. Placenta
      29. D and C
      30. Postpartum
      31. Pregnancy
      32. Regional Block
      33. Retained Placenta
      34. Alpingectomy
      35. Loss
      36. Anesthesia
      37. OB
    2. Obstetric Concepts Considered
      1. 50357 Obstetrics- Uterine Incision
      2. 50050 Obstetrics - Labor Epidural start
      3. 50051 Obstetrics - Labor epidural end
      4. 50189 Obstetrics- Delivery of Neonate 2
      5. 50359 Obstetrics- Apgar score checked at 1 minute note
      6. 50360 Obstetrics- Apgar score 1 minute detail
      7. 50358 Obstetrics- delivery of neonate
      8. 50049 Duration of contractions
      9. 50052 Frequency of contractions
      10. 50596 Obstetrics- labor continued as c-section
      11. 50361 Obstetrics - Vaginal delivery note
      12. 50362 Obstetrics - Vaginal Delivery in/out of OR detail
      13. 50369 Obstetrics- Vaginal Delivery in/out of OR detail
      14. 50373 Obstetrics - Apgar score checked at 5 minute note
      15. 50374 Obstetrics- Apgar score at 5 minute detail
      16. 3181 Frequency of Contractions
      17. 3188 Duration of Contractions
    3. If yes, include case and move to step III
    4. If no, exclude case from phenotype. Return value "No"

Step III: Determine if case is surgical

Evaluate if case includes CPT codes 01963 or 01969 AND has procedure texts including "cesarean" + "hysterectomy", "C-Hyst", or "C Section Hyst"
1. If yes, then assign preliminary result 'Cesarean Hysterectomy'. Proceed to Step V
2. If no, proceed to number 2
Evaluate if case meets any of the following criteria:
1. Meets General Anesthesia criteria as determined by the 'Anesthesia Technique: General' phenotype OR
2. Any of the following between Anesthesia Start (50002) and Anesthesia End (50009)
  1. Uterine Incision (50357)
  2. Surgical Incision Time (50235)
  3. AACD Procedure Start (50006)
  4. AACD Procedure Finish (50007)
3. If ‘No’ then assign preliminary result 'Labor Epidural'. "Proceed to Step V
4. If ‘Yes’ then proceed to Step IV

Step IV: Refine Obstetric surgery type

Determine if Neonate Delivered (50358) is after or at the same time as Procedure Start (50006), Uterine Incision (50357), Surgical Incision Time (50235) or Obstetrics- Labor Epidural Continued as C-Section (50596)
1. If no, then assign preliminary result ‘Unable to Determine'. Proceed to Step V
2. If yes or n/a, move to number 2
Determine if procedure text includes "cesarean" + "hysterectomy", "C-Hyst" or "C Section Hyst" AND does not include text 'with or without hysterectomy'
1. If yes, then assign preliminary result ‘Cesarean Hysterectomy’. Proceed to Step V
2. If no, move to number 3
Determine if anesthesia duration is greater than 240 minutes
1. If yes, move to number 6
2. If no, move to number 4
Determine if Obstetrics-Labor Continued as C-Section (50596) is within 30 minutes of Anesthesia Start (50002)
1. If yes, then assign preliminary result ‘Cesarean Delivery’. Proceed to Step V
2. If no, then move to number 5
3. If n/a, then move to number 6
Determine if Obstetrics-Labor Continued as C-Section (50596) is before the start of any of the surgical criteria listed in Step II
1. If yes, then assign preliminary result ‘Labor Epidural Converted to Cesarean Delivery’. Proceed to Step V
2. If no, then assign preliminary result ‘Cesarean Delivery’. Proceed to Step V
Determine if Anesthesia Start (50002) is >120 minutes before Procedure Start (50006) or Obstetrics-Labor Continues as C-Section (50596), or if Procedure Start not available, if Anesthesia Start is >150 minutes before Surgical Incision (50235) or Uterine Incision (50357)
1. If yes, then assign preliminary result ‘Labor Epidural Converted to Cesarean Delivery’. Proceed to Step V
2. If no, then assign preliminary result ‘Cesarean Delivery’. Proceed to Step V

Step V: Assign Final Decision

If preliminary result 'Unable to Determine' then assign final result 'Unable to Determine'
If preliminary result 'Cesarean Hysterectomy', then check for a 'Labor Epidural' or 'Conversion (Labor Epidural Portion)' case starting or ending within 24 hours after the current case for the same patient
1. If yes, then assign final result 'Conversion (Cesarean Hysterectomy Portion)'
2. If no, then assign final result 'Cesarean Hysterectomy'
If preliminary result 'Cesarean Hysterectomy' then assign final result 'Cesarean Hysterectomy'
If preliminary result 'Labor Epidural Converted to Cesarean Delivery', then assign final result 'Conversion (Labor Epidural and Cesarean Delivery Combined)'
If preliminary result 'Labor Epidural', then check for a 'Cesarean Delivery', 'Conversion (Cesarean Delivery Portion)', 'Conversion (Cesarean Hysterectomy Portion)', or 'Cesarean Hysterectomy' case starting or ending within 24 hours before the current case for the same patient
1. If yes, then assign final result 'Conversion (Labor Epidural Portion)'
2. If no, then assign final result 'Labor Epidural'
If preliminary result 'Cesarean Delivery', then check for a 'Labor Epidural' or 'Conversion (Labor Epidural Portion)' case starting or ending within 24 hours after the current case for the same patient
1. If yes, then assign final result 'Conversion (Cesarean Delivery Portion)'
2. If no, then assign final result 'Cesarean Delivery'