Is information on maternal deliveries available in the Medicaid Analytic eXtract (MAX) data?
Utilization and expenditure data for maternal deliveries and newborn care are included in MSIS and MAX data. However, it may be quite difficult to identify correctly all deliveries (whether or not they result in live births) because of the many ways states permit hospitals and other providers to bill for maternal delivery and newborn care. Initial review of the literature indicated that the best way to identify deliveries is through diagnosis coding in inpatient hospital records. Neither procedure coding in inpatient hospital records nor procedure (service) coding in physician records was determined to consistently identify maternal deliveries. In MAX, coding has been added to assist data users:
MAX Inpatient Hospital File
The MAX Inpatient Hospital file includes the data element “recipient delivery code” (data element #40 for 1999-2004) and “delivery code” (data element #48 for 2005 and later years). This data element is coded for each inpatient hospital record in the file. It has a code value, as follows:
Code value = 0 for all inpatient records that had no indication of a delivery. Hospital records that only have a newborn delivery code and are NOT billed under the mother’s Medicaid ID are not counted as a ‘delivery hospital stay’. Males should have this code value.
Code value = 1 for inpatient records with an indication of a maternal delivery - Both live and still births identified on the basis of any of the following MAX Inpatient Hospital diagnosis codes - 650.0, 640.0 -676.0 (with a 5th digit of ‘1’ or ‘2’), or V27.1-V27.9 - appearing in claims for the stay. This value is assigned if any of the claims for this record have an indication of a maternal delivery. This value is set if there is either a combined mother/newborn delivery claim or a maternal only delivery claim.
Code value = 2 for inpatient records with an indication of a newborn delivery - identified on the basis of any of the following MAX Inpatient Hospital diagnosis codes – V30.-V39. (plus a 4th position value of ‘0’ and any value in the 5th position). This value is assigned only for separate newborn delivery records that are known to contain the mother’s Medicaid identifier. Therefore, these records are a subset of all delivery records.
Coding is defined this way because the focus is on identifying women who delivered at least one baby during the year in the MAX Person Summary File. Often, separate newborn claims without the mother’s ID cannot be linked to the mother’s record. It is also possible that Medicaid only paid for the infant’s delivery.
If there are claims identified as a maternal delivery and as a newborn delivery in the set of claims used to produce the MAX record, there are two separate records created in the MAX inpatient hospital file – one for the mother and one for the newborn.
Inpatient hospital diagnosis and procedure codes can be used to determine other information concerning the delivery (e.g. live birth versus stillborn, delivery by caesarian section, normal birth weight versus pre-maturity).
In contrast, there may be some hospital delivery records for the mother only and some that include the newborn as well. For records that include services for the mother and the newborn, it may not be possible, in all cases, to separately identify services delivered to the mother from services delivered to the newborn. This problem may vary by state and hospital.
Users are warned that the total number of delivery records may produce imprecise count of actual deliveries due to both over- and under-reporting. Over-reporting may occur because there may be more than one stay record for the same maternal delivery (e.g. stays for false labor and/or stays for delivery-related complications). This can occur when maternal stays that do not result in a delivery are coded incorrectly. On the other hand, counts of newborn delivery stays (code value = 2 above) may undercount actual deliveries (or children born under Medicaid).
MAX Person Summary File
The MAX Person Summary file includes the data element “delivery code” (data element #82 for 1999-2004 and data element #95 for 2005 and later years). This data element identifies all females for whom there was at least one inpatient hospital record for a stay during which a delivery occurred. It is set to value = 1 for an eligible woman if there was at least one inpatient hospital record in the year that contained a maternal delivery code, as defined above. This data element has value = 0 for an eligible woman if there was no inpatient hospital record in the year that contained a maternal delivery code. This data element should be set value = 0 for males. This data element is intended to identify those women who have had one or more deliveries in the year. Therefore, this data element does not necessarily count the number of deliveries during the year. For example, multiple births or deliveries following multiple pregnancies in the same year will be counted only once. Users may be able to identify multiple births and/or deliveries by using the MAX Inpatient Hospital file.
It is important to note that the indicator identifies maternal deliveries in the mother’s Inpatient Hospital and Person Summary File records. In some instances the mother may not be eligible for Medicaid. For example, an undocumented alien may receive emergency care under Medicaid, but not be eligible otherwise. The indicator is set in a MAX Person Summary File record only if there is an inpatient hospital record for mother or for the mother and newborn combined. In these cases, there may be no Medicaid enrollment record for the mother, no inpatient hospital service record for the mother and consequently no MAX Person Summary File record with an indicator of a maternal delivery.
As noted in the response to the question “What are the records that are contained in each of the MAX files?” There are instances where there may be no MSIS enrollment records for some Medicaid service recipients. This may be true for some women who had deliveries. In these cases, there is a MAX Person Summary File for the woman that includes ONLY her Medicaid identification number and delivery indicator in the section of the record on eligibility characteristics.
The method of coding maternal deliveries is based on the predominant method of reporting deliveries in each state. Therefore, coding may be incorrect for claims that have been submitted according to alternative reporting methods that do not conform to the predominant reporting method. We did not have the resources to identify all possible reporting methods used in each state and to provide different coding criteria for each method.