Definitions used to define preventive and problem visits

(1)

Steenland MW, Kozhimannil KB, Werner EF, Daw JR. Health care use by commercially insured postpartum and nonpostpartum women in the United States. Obstet Gynecol 2021;137.

The authors provided this information as a supplement to their article.

Definitions used to define preventive and problem visits:

We defined visits as “preventive” if there was any preventive code among any of the claims in a visit. Consistent with previous literature, preventive codes included CPT codes for a preventive office visit (99381-99397).

^15,16

We supplemented this definition with ICD10 diagnostic codes for a general adult medical examination (Z00.00, Z00.01), well woman exam (Z01.411, Z01.419), and postpartum care (Z39.1, Z39.2). We considered a visit to be a “problem visit” if there was no preventive code among any of the claims for the visit. We also identified all ED visits from outpatient claims and all-cause hospitalizations from inpatient claims for both groups of women.

Appendix 1. Health Care Use in the First Year Postpartum Among Women With Commercial Health Insurance in the United States, HCCI Births 2016

Postpartum women with

pregnancy complications

Postpartum Women with chronic disease

Women with cesarean

section

All postpartum women Early postpartum (<21 days) Percent Percent Percent Percent

Preventive visits 16.7 16.2 16.5 15.0

Problem visits 28.2 34.5 28.6 23.7

ED visits 4.3 4.9 4.1 3.2

Hospitalization 1.3 1.3 1.3 0.8

Postpartum (21-60 days)

Preventive visits 29.2 29.2 28.1 28.2

Problem visits 42.6 51.7 40.6 39.4

ED visits 2.3 3.2 2.2 2.0

Hospitalization 0.3 0.5 0.3 0.3

Extended postpartum (day 61-365)

Preventive visits 43.4 46.2 44.3 42.5

Problem visits 80.9 88.6 80.2 79.5

ED visits 12.7 17.6 12.0 11.2

Hospitalization 1.7 2.7 1.6 1.4

N 70,330 23,993 53,085 149,563

NOTE: Preventive visits were visits with any diagnosis code for a preventive office visit (99381-99397), encounter for general adult medical examination (Z00.00, Z00.01), well woman exam (Z01.411, Z01.419), or postpartum care (Z39.1, Z39.2). Problem visits were visits without any preventive codes. Chronic diseases include asthma,

hypertension, and diabetes, and mood or anxiety disorder. Pregnancy complications include placenta previa, preterm labor, gestational diabetes, gestational hypertension, pre-eclampsia, multiple gestation, hemorrhage, infection, laceration, operative injury, and uterine rupture.

(2)

Appendix 2. Health Care Use in the First Year Postpartum Among Women With Commercial Health Insurance in the United States, HCCI Births 2016

Postpartum women with chronic disease

Non-postpartum women with chronic disease

P-value difference between groups

Percent Percent

Preventive visits 16.2 3.9 0.0000

Problem visits 34.5 35.0 0.0799

Any visit 44.5 40.8 0.0000

ED visit 4.9 1.9 0.0000

Inpatient stay 1.3 0.3 0.0000

Preventive visits 29.2 7.8 0.0000

Problem visits 51.7 50.0 0.0000

Any visit 65.9 56.7 0.0000

ED visit 3.2 3.5 0.0094

Inpatient stay 0.5 0.6 0.0224

Preventive visits 46.2 49.7 0.0000

Problem visits 88.6 90.9 0.0000

Any visit 91.0 95.5 0.0000

ED visit 17.6 18.7 0.0001

Inpatient stay 2.7 3.7 0.0000

N 23,993 439,045

(3)

Appendix 3. Health Care Use Among Recently Pregnant Women and Nonpregnant or Postpartum Women With Commercial Health Insurance in the United States

All postpartum women

Comparison women

Difference (unadjusted)

Difference (adjusted) Early n Percent n Percent Percentage point Percent point Preventive visits 22,502 15.0 66,011 3.3 11.7* (11.6,11.8) 11.6* (11.5,11.7) Problem visits 35,470 23.7 414,219 19.7 4.0* (3.8,4.3) 4.8* (4.6,5.0) ED visit 4,731 3.2 21,716 1.0 2.2* (2.1,2.3) 2.3* (2.2,2.4) Inpatient stay 1,190 0.8 2,382 0.1 0.7* (0.6,0.7) 0.7* (0.7,0.7) Postpartum

Preventive visits 42,154 28.2 133,047 6.5 21.6* (21.5,21.8) 21.4* (21.3,21.5) Problem visits 58,903 39.4 649,563 30.2 9.2* (8.9,9.4) 10.2* (9.9,10.4) ED visit 2,918 2.0 42,937 1.9 0.1 (0.0,0.2) 0.3* (0.2,0.4) Inpatient stay 400 0.3 5,765 0.2 0.0 (-0.0,0.0) 0.1*** (0.0,0.1) Extended

Preventive visits 63,539 42.5 936,814 42.7 -0.3* (-0.5,-0.0) -1.8* (-2.1,-1.5) Problem visits 118,843 79.5 1,587,23 72.8 6.6* (6.4,6.9) 6.5* (6.2,6.7) ED visit 16,805 11.2 248,533 11.1 0.2 (-0.0,0.3) 1.1* (0.9,1.2) Inpatient stay 2,143 1.4 36,847 1.6 -0.2* (-0.2,-0.1) 0.1 (0.0,0.2)

N 149,563 2,048,83 2,198,394 2,198,394

(4)

Appendix 4. Diagnosis Code Definitions for Chronic Disease and Pregnancy Complications

ICD-9-CM ICD10-CM

Chronic disease

Asthma 493.xx J45

Hypertension 401.1; 401.9 Essential hypertension

401.0; 402.xx; 403.xx; 404.xx; 405.xx; 437.2 Hypertension with complications and secondary hypertension

I10 Essential hypertension

I11.x; I12.x; I13.xx, I15.x, I67.4; N26.2 Hypertension with complications and secondary hypertension

Mood disorders/

Anxiety disorders

296 Episodic mood disorders 300.0X Anxiety states 300.2X Phobic disorders

300.3 Obsessive-compulsive disorder

F30 Manic episode F31 Bipolar disorder

F32 Major depressive disorder, single episode F33 Major depressive disorder, recurrent F34 Persistent mood [affective] disorders F39 Unspecified mood [affective] disorder F40 Phobic anxiety disorders

F41 Other anxiety disorders F42 Obsessive-compulsive disorder

F43 Reaction to severe stress, and adjustment disorders

F44 Dissociative and conversion disorders F45 Somatoform disorders

F48 Other nonpsychotic mental disorders Diabetes 250.xx Diabetes mellitus

357.2 Polyneuropathy in diabetes 362.0X Diabetic retinopathy 366.41 Diabetic cataract V45.85 Insulin pump status

V53.91 Fitting/adjustment of insulin pump, insulin pump titration

V65.46 Encounter for insulin pump training 996.57 Mechanical complications, due to insulin pump

E10 Type 1 diabetes mellitus E11 Type 2 diabetes mellitus E13 Other specified diabetes mellitus Z96.41 Presence of insulin pump (external) (internal)

Z46.81 Encounter for fitting and adjustment of insulin pump

T85.614A Breakdown (mechanical) of insulin pump, initial encounter

T85.624A Displacement of insulin pump, initial encounter

T85.633A Leakage of insulin pump, initial encounter

T85.694A Other mechanical complication of insulin pump, initial encounter

Pregnancy and birth complications Placenta

previa

641.0 Placenta previa without hemorrhage 641.1 Hemorrhage from placenta previa 667 Retained placenta or membranes without hemorrhage

O44.0 Complete placenta previa NOS or without hemorrhage

O44.1 Complete placenta previa with hemorrhage

O73.0 Retained placenta without hemorrhage Preterm

labor

644 Early or threatened labor O60 Preterm labor

(5)

ICD-9-CM ICD10-CM

Gestational diabetes

648.8x Abnormal glucose tolerance of mother complicating pregnancy childbirth or the puerperium

O99.81 Abnormal glucose complicating pregnancy, childbirth and the puerperium O24.4 Gestational diabetes mellitus Gestational

hypertension

642.3x Transient hypertension of pregnancy O12 Gestational [pregnancy-induced] edema and proteinuria without hypertension O13 Gestational [pregnancy-induced]

hypertension without significant proteinuria O16 Unspecified maternal hypertension Preeclampsia 642.4x Mild or unspecified pre-eclampsia

642.7x Pre-eclampsia or eclampsia superimposed on pre-existing hypertension 642.5x Severe pre-eclampsia

642.6x Eclampsia

O14 Pre-eclampsia O15 Eclampsia

Multiple gestation

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.x Multiple gestation

Z37.2-Z37.7

O30 Multiple gestation

Hemorrhage 287.4 Secondary thrombocytopenia 648.22 Anemia of mother, delivered, with mention of postpartum complication 649.32 Coagulation defects complicating pregnancy, childbirth, or the puerperium, delivered, with mention of postpartum complication

666.02 Third-stage postpartum hemorrhage, delivered, with mention of postpartum complication

666.04 Third-stage postpartum hemorrhage, postpartum condition or complication

666.1 Other immediate postpartum hemorrhage (including 666.12, 666.14)

666.2 Delayed and secondary postpartum hemorrhage (including 666.22, 666.24) 666.32 Postpartum coagulation defects, delivered, with mention of postpartum complication

667.02 Retained placenta without hemorrhage, delivered, with mention of postpartum

667.12 Retained portions of placenta or membranes, without hemorrhage, delivered, with mention of postpartum complication 998.11 Hemorrhage complicating a procedure

D69.59 other secondary thrombocytopenia O99.03 Anemia complicating the puerperium O99.13 Other diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism

complicating the puerperium O72 Postpartum hemorrhage O72.1 Other immediate postpartum hemorrhage

O72.2 Delayed and secondary postpartum hemorrhage

O72.3 Postpartum coagulation defects O73.0 Retained placenta without hemorrhage O73.1 Retained portions of placenta and membranes, without hemorrhage

I97.6 Postprocedural hemorrhage, hematoma and seroma of a circulatory system organ or structure following a procedure

(6)

ICD-9-CM ICD10-CM

Infection 646.62 Infections of genitourinary tract in pregnancy, delivered, with mention of postpartum complication

670.02 Major puerperal infection, delivered, with mention of postpartum complication 672.02 Pyrexia of unknown origin during the puerperium, delivered, with mention of postpartum complication

996.60 Infection and inflammatory reaction due to unspecified device, implant, and graft 996.62 Infection and inflammatory reaction due to other vascular device, implant, and graft 999.3 Other infection due to medical care not elsewhere classified

O23.9 Unspecified genitourinary tract infection in pregnancy

O86.89 Other specified puerperal infections O86.4 Pyrexia of unknown origin following delivery

T85.79XA Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, initial encounter T82.7XXA Infection and inflammatory reaction due to other cardiac and vascular

Laceration 664.21 Third-degree perineal laceration, delivered, with or without mention of antepartum condition

664.31 Fourth-degree perineal laceration, delivered, with or without mention of antepartum condition

664.41 Unspecified perineal laceration, delivered, with or without mention of antepartum condition

664.51 Vulvar and perineal hematoma, delivered, with or without mention of antepartum condition

664.61 Anal sphincter tear complicating delivery, not associated with third-degree perineal laceration, delivered, with or without mention of antepartum condition

664.81 Other specified trauma to perineum and vulva, delivered, with or without mention of antepartum condition

664.91 Unspecified trauma to perineum and vulva, delivered, with or without mention of antepartum condition

665.31 Laceration of cervix, delivered, with or without mention of antepartum condition 665.41 High vaginal laceration, delivered, with or without mention of antepartum condition 674.22 Disruption of perineal wound, delivered, with mention of postpartum complication

O70.2 Third degree perineal laceration during delivery

O70.3 Fourth degree perineal laceration during delivery

O70.9 Perineal laceration during delivery, unspecified

O71.7 Obstetric hematoma of pelvis O70.4 Anal sphincter tear complicating O71.82 Other specified trauma to perineum and vulva

O71.9 Obstetric trauma, unspecified O71.3 Obstetric laceration of cervix

O71.4 Obstetric high vaginal laceration alone O90.1 Disruption of perineal obstetric wound

Operative Injury

669.42 Other complications of obstetrical surgery and procedures, delivered, with mention of postpartum complication

998.20 Accidental puncture or laceration during a procedure, unspecified site

998.4 Foreign body accidentally left during a procedure

999.83 Hemolytic transfusion reaction, incompatibility unspecified

O75.4 Other complications of obstetric surgery and procedures

T81.509A Unspecified complication of foreign body accidentally left in body following unspecified procedure, initial encounter

Or: T81.519A, T81.529A, T81.539A

(7)

ICD-9-CM ICD10-CM

T80.919A Hemolytic transfusion reaction, unspecified incompatibility, unspecified as acute or delayed, initial encounter

Uterine rupture

665.0 Rupture of uterus before onset of labor 665.1 Rupture of uterus during labor

O71.0 Rupture of uterus before onset of labor O71.1 Rupture of uterus during labor

Definitions used to define preventive and problem visits