Change Request Detail
No.
1196
Date
10/9/2014
Submitter
Type of Request
Pertaining to more than one, or not sure
Status
DSMO Process Completed
Business Reason
HCFA 1500 Form and the 837P
Currently, Field 14 of the CMS 1500 form and its electronic version, the 837P, allows a provider to document the "Date of Current Illness, Injury or Pregnancy (LMP)". It is well known that the LMP is not as reliable a source for the pregnancy due date as is ultrasound confirmation of the due date. I am requesting that providers be allowed to enter the estimated delivery date in this field on the paper form and in its counterpart on the 837P along with a new qualifier specific to the estimated delivery date. This change will allow state Medicaid programs to determine gestational age from claims data and subsequently allow for the generation and reporting to CMS of performance measure rates related to gestational age - elective deliveries and antenatal steroid use. These performance measure rates are included in the CMS Adult Core Set of Measures that CMS has asked Medicaid programs to report and states are handicapped in identifying the target population prior to generating a sample for medical record review without this capability. 
Suggestion
Modification of Field 14 on the paper CMS 1500 form and its electronic counterpart, the 837P, to allow for the documentation of the estimated delivery date and a qualifier, if needed after the modification, that is specific to the estimated delivery date. The estimated delivery date would be based on ultrasound confirmation of the due date.
DSMO Category
D
Recommendation
Disapprove.  DSMO believes that the business reason is inadequate to support adding such a data element at this time.
Appeal Recommendation
Appeal Denied
SDOs do not repurpose fields. One date will not meet the needs of everyone.