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Prenatal and Postpartum Care (PPC)

HEDIS Measure

Prenatal and Postpartum Care (PPC)

Line of business: Commercial Medicaid

Data Collection Method: Administrative and Hybrid

Measure Description

The percentage of deliveries of live births on or between October 8 of the year prior to the measurement year and October 7 of the measurement year. For these women, the measure assesses the following facets of prenatal and postpartum care.

  • Timeliness of Prenatal Care. The percentage of deliveries that received a prenatal care visit in the first trimester, on or before the enrollment start date or within 42 days of enrollment in the organization.
  • Postpartum Care. The percentage of deliveries that had a postpartum visit on or between 7 and 84 days after delivery.

Numerator Compliance

Timeliness of Prenatal Care - A prenatal visit during the required time frame.

Either of the following meets compliance:

  • A prenatal visit with an OB/GYN or other prenatal care practitioner or PCP, during the first trimester if the members was continuously enrolled (with no gaps) from at least 219 days before delivery (or EDD) through 60 days after delivery.
  • A prenatal visit with an OB/GYN or other prenatal care practitioner or PCP, any time during the period that begins 280 days prior to delivery and ends 42 days after their enrollment start date if the member was not continuously enrolled (with no gaps) from at least 219 days before delivery (or EDD) through 60 days after delivery.

Postpartum Care - A postpartum visit on or between 7 and 84 days after delivery.

Documentation in the medical record must include a note indicating the date when a postpartum visit occurred and one of the following:

  • Pelvic exam
  • Evaluation of weight, BP, breasts and abdomen
    • Notation of “breastfeeding” is acceptable for the “evaluation of breasts” component
  • Notation of postpartum care, including, but not limited to:
    • Notation of “postpartum care,” “PP care,” “PP check,” “6-week check”
    • A preprinted “Postpartum Care” form in which information was documented during the visit
  • Perineal or cesarean incision/wound check.
  • Screening for depression, anxiety, tobacco use, substance use disorder, or preexisting mental health disorders
  • Glucose screening for women with gestational diabetes
  • Documentation of any of the following topics:
    • Infant care or breastfeeding.
    • Resumption of intercourse, birth spacing or family planning.
    • Sleep/fatigue.
    • Resumption of physical activity
    • Attainment of healthy weight

Best Practices

  • Stress and educate patients on the importance of the prenatal/initial visit
  • Review the visit schedule with the patient
  • Connect patients to resources for family assistance programs in New Jersey
  • Encourage patients to maintain the relationship with an OB/GYN to promote consistent and coordinated health care
  • Educate patients on the importance of keeping each prenatal visit and post-partum visit
  • Consider offering extended practice hours to increase care access
  • Remind patients of their appointment by making calls or sending texts
  • Make outreach calls and/or send letters to advise members of the need for a visit
  • Partner with Horizon Healthy Journey Program to assist with targeted outreach activities

Quality Value Set Directory Coding Tips

Cervical Cytology Lab Test

CPT

  • 88141
  • 88142
  • 88143
  • 88147
  • 88148
  • 88150
  • 88152
  • 88153
  • 88154
  • 88164
  • 88165
  • 88166
  • 88167
  • 88174
  • 88175

HCPCS

  • G0123
  • G0124
  • G0141
  • G0143
  • G0144
  • G0145
  • G0147
  • G0148
  • P3000
  • P3001
  • Q0091

LOINC

  • 10524-7
  • 18500-9
  • 19762-4
  • 19764-0
  • 19765-7
  • 19766-5
  • 19774-9
  • 33717-0
  • 47527-7
  • 47528-5

SNOMED CT US Edition

  • 171149006
  • 416107004
  • 417036008
  • 440623000
  • 448651000124104

Cervical Cytology Result or Finding

SNOMED CT US Edition

  • 168406009
  • 168407000
  • 168408005
  • 168410007
  • 168414003
  • 168415002
  • 168416001
  • 168424006
  • 250538001
  • 268543007
  • 269957009
  • 269958004
  • 269959007
  • 269960002
  • 269961003
  • 269963000
  • 275805003
  • 281101005
  • 309081009
  • 310841002
  • 310842009
  • 416030007
  • 416032004
  • 416033009
  • 439074000
  • 439776006
  • 439888000
  • 441087007
  • 441088002
  • 441094005
  • 441219009
  • 441667007
  • 700399008
  • 700400001
  • 62051000119105
  • 62061000119107
  • 98791000119102

Online Assessments

CPT

  • 98969
  • 98970
  • 98971
  • 98972
  • 99421
  • 99422
  • 99423
  • 99444
  • 99457

HCPCS

  • G0071
  • G2010
  • G2012
  • G2061
  • G2062
  • G2063

Postpartum Bundled Services

CPT

  • 59400
  • 59410
  • 59510
  • 59515
  • 59610
  • 59614
  • 59618
  • 59622

Postpartum Visits

CPT

  • 57170
  • 58300
  • 59430
  • 995019

CPT-CAT-II

  • 0503F

HCPCS

  • G0101

ICD10CM

  • Z01.411
  • Z01.419
  • Z01.42
  • Z30.430
  • Z39.1
  • Z39.2

SNOMED CT US Edition

  • 133906008
  • 133907004
  • 169762003
  • 169770008
  • 169771007
  • 169772000
  • 384634009
  • 384635005
  • 384636006
  • 408883002
  • 408884008
  • 408886005
  • 409018009
  • 409019001
  • 431868002
  • 440085006
  • 717810008

Pregnancy Diagnosis

* Per NCQA HEDIS Specifications there are over 900 codes - For additional codes, please email Quality_RR@HorizonBlue.com

ICD10CM

  • O09.00
  • O09.01
  • O09.02
  • O09.03
  • O09.10
  • O09.11
  • O09.12
  • O09.13
  • O09.211
  • O09.212
  • O09.213
  • O09.219
  • O09.291
  • O09.292
  • O09.293
  • O09.299
  • O09.30
  • O09.31
  • O09.32
  • O09.33
  • O09.40
  • O09.41
  • O09.42
  • O09.43
  • O09.511
  • O09.512
  • O09.513
  • O09.519
  • O09.521
  • O09.522
  • O09.523
  • O09.529
  • O09.611
  • O09.612
  • O09.613
  • O09.619
  • O09.621
  • O09.622
  • O09.623
  • O09.629
  • O09.70
  • O09.71
  • O09.72
  • O09.73
  • O09.811
  • O09.812
  • O09.813
  • O09.819
  • O09.821
  • O09.822
  • O09.823
  • O09.829
  • O09.891
  • O09.892
  • O09.893
  • O09.899
  • O09.90
  • O09.91
  • O09.92
  • O09.93
  • O09.A0
  • O09.A1
  • O09.A2
  • O09.A3
  • O10.011
  • O10.012
  • O10.013
  • O10.019
  • O10.111
  • O10.112
  • O10.113
  • O10.119
  • O10.211
  • O10.212
  • O10.213
  • O10.219
  • O10.311
  • O10.312
  • O10.313
  • O10.319
  • O10.411
  • O10.412
  • O10.413
  • O10.419
  • O10.911
  • O10.912
  • O10.913
  • O10.919
  • O11.1
  • O11.2
  • O11.3
  • O11.9
  • O12.00
  • O12.01
  • O12.02
  • O12.03
  • O12.10
  • O12.11
  • O12.12
  • O12.13
  • O12.20
  • O12.21
  • O12.22
  • O12.23
  • O13.1
  • O13.2
  • O13.3
  • O13.9
  • O14.00
  • O14.02
  • O14.03
  • O14.10
  • O14.12
  • O14.13
  • O14.20
  • O14.22
  • O14.23
  • O14.90
  • O14.92
  • O14.93
  • O15.00
  • O15.02
  • O15.03
  • O15.1
  • O15.9
  • O16.1
  • O16.2
  • O16.3
  • O16.9
  • O20.0
  • O20.8
  • O20.9
  • O21.0
  • O21.1
  • O21.2
  • O21.8
  • O21.9
  • O22.00
  • O22.01
  • O22.02
  • O22.03
  • O22.10
  • O22.11
  • O22.12
  • O22.13
  • O22.20
  • O22.21
  • O22.22
  • O22.23
  • O22.30
  • O22.31
  • O22.32
  • O22.33
  • O22.40
  • O22.41
  • O22.42
  • O22.43
  • O22.50
  • O22.51
  • O22.52
  • O22.53
  • O22.8X1
  • O22.8X2
  • O22.8X3
  • O22.8X9

SNOMED CT US Edition

  • 9279009
  • 9899009
  • 14418008
  • 16356006
  • 29399001
  • 31601007
  • 34801009
  • 38720006
  • 41587001
  • 41991004
  • 43990006
  • 44782008
  • 45307008
  • 47200007
  • 57630001
  • 58532003
  • 59466002
  • 60000008
  • 60810003
  • 64254006
  • 65147003
  • 65727000
  • 69532007
  • 72892002
  • 77386006
  • 79290002
  • 79586000
  • 80997009
  • 82661006
  • 83074005
  • 87605005
  • 90968009
  • 102872000
  • 102873005
  • 102875003
  • 127363001
  • 169560008
  • 169561007
  • 169562000
  • 169563005
  • 169564004
  • 169565003
  • 169566002
  • 169567006
  • 169568001
  • 198624007
  • 198626009
  • 198627000
  • 199715003
  • 237233002
  • 237238006
  • 237239003
  • 237240001
  • 237241002
  • 237242009
  • 237244005
  • 239101008
  • 248985009
  • 281307002
  • 314204000
  • 442478007

Prenatal Bundled Services

CPT

  • 59400
  • 59425
  • 59426
  • 59510
  • 59610
  • 59618

HCPCS

  • H1005

Prenatal Visits

CPT

  • 99201
  • 99202
  • 99203
  • 99204
  • 99205
  • 99211
  • 99212
  • 99213
  • 99214
  • 99215
  • 99241
  • 99242
  • 99243
  • 99244
  • 99245
  • 99483

HCPCS

  • G0463
  • T1015

SNOMED CT US Edition

  • 77406008
  • 281036007

Stand Alone Prenatal Visits

CPT

  • 99500

CPT-CAT-II

  • 0500F
  • 0501F
  • 0502F

HCPCS

  • H1000
  • H1001
  • H1002
  • H1003
  • H1004

SNOMED CT US Edition

  • 17629007
  • 18114009
  • 58932009
  • 66961001
  • 134435003
  • 135892000
  • 169712008
  • 169713003
  • 169714009
  • 169715005
  • 169716006
  • 169717002
  • 169718007
  • 169719004
  • 169720005
  • 169721009
  • 169722002
  • 169723007
  • 169724001
  • 169725000
  • 169726004
  • 169727008
  • 171054004
  • 171055003
  • 171056002
  • 171057006
  • 171058001
  • 171059009
  • 171060004
  • 171061000
  • 171062007
  • 171063002
  • 171064008
  • 386235000
  • 386322007
  • 397931005
  • 406145006
  • 409010002
  • 422808006
  • 424441002
  • 424525001
  • 424619006
  • 439165004
  • 439733009
  • 439816006
  • 439908001
  • 440047008
  • 440227005
  • 440309009
  • 440536005
  • 440638004
  • 440669000
  • 440670004
  • 440671000
  • 441839001
  • 700256000
  • 702396006
  • 702736005
  • 702737001
  • 702738006
  • 702739003
  • 702740001
  • 702741002
  • 702742009
  • 702743004
  • 702744005
  • 710970004
  • 713076009
  • 713233004
  • 713234005
  • 713235006
  • 713237003
  • 713238008
  • 713239000
  • 713240003
  • 713241004
  • 713242006
  • 713386003
  • 713387007
  • 717794008
  • 717795009

Telephone Visits

CPT

  • 98966
  • 98967
  • 98968
  • 99441
  • 99442
  • 99443

SNOMED CT US Edition

  • 185317003
  • 314849005
  • 386472008
  • 386473003
  • 401267002