HEDIS^® Tip Sheet

Prenatal & Postpartum Care (PPC)

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 members, 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.

Notes

• First Trimester is defined as 280-176 days prior to delivery or the estimated delivery date (EDD).
• Remove multiple deliveries in a 180-day period. If a person has more than one delivery in a 180-day period, include only the first eligible delivery. Then, if applicable, include the next delivery that occurs after the 180-day period. Identify deliveries chronologically, including only one per 180-day period.
• Members who had multiple live births during one pregnancy count once (e.g., pregnancy with twins).

Prenatal Visits

• Visit must take place in the first trimester or within 42 days of enrollment with BCBSND coverage.
• The last menstrual period (LMP) may not be used to determine first trimester; must be determined with EDD. 
• Visit must be with an OB/GYN, other prenatal care practitioner, or PCP.
• Ultrasounds and lab visits alone are not considered a visit.
• Any of the following meet criteria: 
  • Prenatal Care Visit with a pregnancy related diagnosis code.
  • Bundled service including the date when the prenatal care was initiated. 

Medical Records for Prenatal Visit must include:

• Visits with a PCP must have a diagnosis of pregnancy.
• Prenatal Care documentation must include a note indicating the date the prenatal care visits occurred and evidence of one of the following:
  • Documentation indicating the member is pregnant or references to the pregnancy in the medical record such as:
    • Prenatal flowsheet; or
    • Last menstrual period (LMP), EDD, or gestational age; or
    • Positive pregnancy test results; or
    • Gravidity and parity; or
    • Complete obstetrical history; or
    • Prenatal risk assessment and counseling/education.
  • Physical obstetrical examination that includes fetal heart tone or pelvic exam with obstetrical observations, or fundus height measurement.
  • Evidence that prenatal care was given:
    • Obstetrical panel or
    • Torch antibody panel alone, or
    • Rubella antibody test/titer with RH incompatibility blood typing, or
    • Ultrasound of pregnant uterus. 

Exclusions:

• Pregnancies that do not result in a live birth.
• Members in hospice during the measurement year.
• Member who died during the measurement year.

Prenatal Best Practices

• Explain the importance of completing the initial prenatal visit early in pregnancy.
• Refer patients to appropriate community and family assistance resources, as needed.
• Encourage patients to continue care with an OB/GYN or PCP to support consistent, coordinated prenatal care.
• Reinforce the importance of attending all scheduled prenatal visits.
• Consider extended or flexible appointment hours to improve access to prenatal care.
• Use appointment reminders, such as phone calls, text messages, and patient portal notifications, to support prenatal visit adherence.

Postpartum Care

• Visit must take place on or between 7 and 84 days after delivery.
• Postpartum care must occur with an OB/GYN, other prenatal care practitioner, or a PCP.
• Postpartum care in an acute inpatient setting cannot be included.
• Any of the following meet criteria: 
  • Postpartum visit.
  • Cervical Cytology
  • Bundled service including the date when the postpartum care was rendered.

Medical Records for Postpartum Care must include:

• Postpartum Care documentation must include the date the postpartum care visit occurred and evidence of one of the following:
  • Pelvic Exam
    • A pap test is considered evidence of a pelvic exam.
  • Evaluation of weight, blood pressure, breasts, and abdomen.
  • Perineal or cesarean incision wound check.
  • Screening for depression, anxiety, tobacco use, substance use, or preexisting mental health disorder.
  • Glucose screening for members with gestational diabetes.
  • Documentation on the following topics:
    • Infant care/breastfeeding.
    • Sleep/fatigue
    • Resuming physical activity
    • Healthy weight.
    • Resuming intercourse, birth spacing, family planning.

Exclusions:

• Pregnancies that do not result in a live birth.
• Postpartum services provided in an acute inpatient setting.
• Members in hospice during the measurement year.
• Member who died during the measurement year.

Postpartum Best Practices:

• Explain the importance of completing a timely postpartum visit.
• Review the postpartum visit schedule with the patient before discharge from inpatient care.
• Refer patients to appropriate community and family assistance resources, as needed.
• Encourage patients to continue care with an OB/GYN or PCP to support coordinated postpartum care.
• Consider extended or flexible appointment hours to improve access to postpartum care.
• Schedule the postpartum visit before the patient is discharged from the hospital.
• Use appointment reminders, such as phone calls, text messages, and patient portal notifications, to support postpartum visit adherence.
• Conduct outreach calls and send letters, as appropriate, to remind members of the need for a postpartum visit.