Product Lines:
EHP, Priority Partners, and USFHP.

Measurement Period: January 1 - December 31
 
Description:
The percentage of deliveries in the measurement period in which persons received influenza and tetanus, diphtheria toxoids and acellular pertussis (Tdap) vaccinations.

Stratifications: 
Report stratification by race and ethnicity.

Measure Reporting:
HealthChoice Performance Measure reporting for Priority Partners. 

Data Collection:

• ECDS. 
  

Initial Population:

• Measure Item Count: Episode.
• Age: None.
• Benefits: Medical.
• Continuous Enrollment: From 28 days prior to the delivery date through the delivery date.
• Allowable Gap: None. 

Denominator:
Deliveries.
Deliveries, in any setting, during the measurement period that have a gestational age assessment or gestational age diagnosis within 1 day of the start or end of the delivery.

Note: The measure is based on deliveries; therefore, it is possible for denominator to include multiple deliveries for the same person. Only the first eligible delivery in a 180-day period is included. 

Numerator:
Numerator 1: Immunization Status—Influenza

• Deliveries where persons received an adult influenza vaccine on or between July 1 of the year prior to the measurement period and the delivery date, or
• Deliveries where persons had anaphylaxis due to the influenza vaccine on or before the delivery date.

Numerator 2: Immunization Status—Tdap

• Deliveries where persons received at least one Tdap vaccine during the pregnancy (including on the delivery date), or
• Deliveries where persons had any of the following:
  • Anaphylaxis due to the diphtheria, tetanus or pertussis vaccine on or before the delivery date.
  • Encephalitis due to the diphtheria, tetanus or pertussis vaccine on or before the delivery date.

Numerator 3: Immunization Status—Combination
Deliveries that met criteria for both numerator 1 and numerator 2. 

Best Practice and Measure Tips

• Identify members with gap. Offer immunization to members during prenatal visits or when admitted for delivery.
• Use appropriate and accurate codes on claims 
• Centers for Disease Control and Prevention recommend that pregnant member receive the following immunizations:
  • A flu shot during any trimester of their pregnancy to protect themselves and their newborn babies from flu
  • 1 dose of Tdap every pregnancy, preferably during early part of gestational weeks 27–36
  • For patient and provider resources, visit: www.cdc.gov/vaccines/pregnancy

Measure Exclusions

Denominator Exclusions:

• Deliveries that occurred at less than 37 weeks gestation.
• Deliveries in which persons were in hospice or using hospice services any time during the measurement period.
• Persons who die any time during the measurement period.

Measure Codes

Adult Influenza

• CPT:  90653, 90656, 90658, 90661, 90662, 90673, 90674, 90682, 90686, 90688, 90689, 90694, 90756
• CVX: 88, 135, 140, 141, 144, 150, 153, 155, 158, 166, 168, 171, 185, 186, 197, 205, 320
• Anaphylaxis due to the influenza vaccine SNOMED: 471361000124100

Tdap

• CPT: 90715
• CVX: 115
• Anaphylaxis Due to Diphtheria, Tetanus or Pertussis Vaccine:
  • SNOMED: 428281000124107, 428291000124105
• Encephalitis Due to Diphtheria, Tetanus or Pertussis Vaccine
  • SNOMED: 192710009, 192711008, 192712001

Weeks of Gestation Diagnosis Code

• ICD-10-CM: Z3A.01, Z3A.08, Z3A.09, Z3A.10, Z3A.11, Z3A.12, Z3A.13, Z3A.14, Z3A.15, Z3A.16, Z3A.17, Z3A.18, Z3A.19, Z3A.20, Z3A.21, Z3A.22, Z3A.23, Z3A.24, Z3A.25, Z3A.26, Z3A.27, Z3A.28,  Z3A.29, Z3A.30, Z3A.31, Z3A.32, Z3A.33, Z3A.34, Z3A.35, Z3A.36, Z3A.37, Z3A.38, Z3A.39, Z3A.40, Z3A.41, Z3A.42, Z3A.49