Measure ID: MIPS 432|Gynecology|2026 Performance Year

Proportion of Patients Sustaining a Bladder or Bowel Injury at the time of any Pelvic

Percentage of patients undergoing surgical repair of pelvic organ prolapse that is complicated by a bladder or bowel injury at the time of index surgery that is recognized intraoperatively or within 30 days after surgery.

Outcome – High PriorityGynecologyPatient SafetyUrology

Last updated: January 15, 2026

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Measure Specification

Denominator (Eligible Population)

Submission Criteria 1
All patients, regardless of age
ANDPatient procedure during the denominator identification period
ORDenominator Exception: Documented medical reasons for not reporting bladder injury (e.g. gynecologic or other pelvic malignancy documented, concurrent surgery involving bladder pathology, injury that occurs during a urinary incontinence procedure, patient death from non-medical causes not related to surgery, patient died during procedure without evidence of bladder injury) (G9626)
ORPerformance Met: Patient sustained bladder injury at the time of surgery or discovered subsequently up to 30 days post-surgery (G9625)
Submission Criteria 2
ANDSUBMISSION CRITERIA 2: ALL PATIENTS UNDERGOING ANTERIOR, POSTERIOR, OR APICAL PELVIC ORGAN PROLAPSE (POP) SURGERY WHO SUSTAIN A BOWEL INJURY. DENOMINATOR (CRITERIA 2): All patients undergoing anterior, posterior, or apical pelvic organ prolapse (POP) surgery.
ANDPatient procedure during the denominator identification period
ORDenominator Exception: Documented medical reasons for not reporting bowel injury (e.g. gynecologic or other pelvic malignancy documented, planned (e.g. not due to an unexpected bowel injury) resection and/or re-anastomosis of bowel, or patient death from non-medical causes not related to surgery, patient died during procedure without evidence of bowel injury) (G9629)
ORPerformance Met: Patient sustained bowel injury at the time of surgery or discovered subsequently up to 30 days post-surgery (G9628)

Denominator Exclusions

None

Numerator

Criteria 1Percentage of patients undergoing prolapse repair who sustain a bladder injury that necessitates repair either intraoperatively or within 30 days after surgery.

Submission Codes (QDCs)

✓ Performance Met
G9625Patient sustained bladder injury at the time of surgery or discovered subsequently up to 30 days post-surgery
G9628Patient sustained bowel injury at the time of surgery or discovered subsequently up to 30 days post-surgery
✗ Performance Not Met
G9627Patient did not sustain bladder injury at the time of surgery nor discovered subsequently up to 30 days post-surgery
G9630Patient did not sustain a bowel injury at the time of surgery nor discovered subsequently up to 30 days post-surgery

Denominator Exceptions

G9626Documented medical reasons for not reporting bladder injury (e.g. gynecologic or other pelvic malignancy documented, concurrent surgery involving bladder pathology, injury that occurs during a urinary incontinence procedure, patient death from non-medical causes not related to surgery, patient died during procedure without evidence of bladder injury)
G9629Documented medical reasons for not reporting bowel injury (e.g. gynecologic or other pelvic malignancy documented, planned (e.g. not due to an unexpected bowel injury) resection and/or re-anastomosis of bowel, or patient death from non-medical causes not related to surgery, patient died during procedure without evidence of bowel injury)

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VBCA Insights

💡Why This Measure Matters

Bladder and bowel injuries happen in 0.1–4% of prolapse surgeries depending on the approach, and when injuries go unrecognized, mortality from sepsis can jump from 2% to 23%. This is an inverse measure—lower rates are better, meaning you're catching and fixing injuries in real time. The key is either performing cystoscopy and proctoscopy during the procedure or having a low threshold for imaging and return to the OR if you suspect injury.

📖Clinical Rationale

There are numerous approaches to surgical correction of pelvic organ prolapse- vaginal, open, laparoscopic and robotic. The incidence of visceral injury ranges from 0.1-4%, depending on the approach, with high potential for morbidity. Unrecognized injury to the intestine increases the risk of mortality from 2 to 23% (Chapron et al. J Am Coll Surg. 1991;185:461-465, Baggish, MS J Gynecol Surg.

2003;19:63-73). It is critically important for surgeons who are performing these procedures to recognize and repair any visceral injuries intraoperatively, in order to minimize postoperative morbidity, including the need for subsequent surgical intervention to address these complications. Surgeons benefit from interventions to improve the quality of their surgical care if they have a higher than expected rate of visceral injury during pelvic organ prolapse repair.

Bladder injury is a common and potentially debilitating complication of pelvic surgery but more common in surgery for pelvic organ prolapse. Surgeons may benefit from interventions to improve the quality of their surgical care if they have a higher than expected rate of bladder injury during pelvic organ prolapse repair.

📝Clinical Recommendations

There are numerous approaches to surgical correction of pelvic organ prolapse- vaginal, open, laparoscopic and robotic. The incidence of visceral injury ranges from 0.1-4% (SGS Systemic Review Obstet Gynecol 2008: 112: 1131- 1142) depending on the approach with high potential for morbidity. Unrecognized injury to the intestine increases the risk of mortality from 2 to 23 %

📋Implementation Notes

This measure contains two strata defined by two submission criteria. This measure produces two performance rates which are used for a simple average. There are 2 Submission Criteria for this measure: 1) All patients undergoing anterior or apical pelvic organ prolapse (POP) surgery who sustain a bladder injury. AND 2) All patients undergoing anterior, posterior, or apical pelvic organ prolapse (POP) surgery who sustain a bowel injury.

This measure contains two submission criteria which together ensure that the proper evaluation and treatment is provided for patients who undergo pelvic organ prolapse repair. Submission Criteria 1 evaluates whether patients sustained a bladder injury intraoperatively or within 30 days after surgery. Submission Criteria 2 evaluates whether patients sustained a bowel injury intraoperatively or within 30 days after surgery.

Patients who undergo a procedure that meets the denominator of both submission criteria should be included in both and assessed for each clinical outcome. This measure will be calculated with 2 performance rates: 1) Percentage of patients undergoing prolapse repair who sustain a bladder injury that necessitates repair either intraoperatively or within 30 days after surgery.

2) Percentage of patients undergoing prolapse repair who sustain a bowel injury that necessitates repair either intraoperatively or within 30 days after surgery. Submission of the two performance rates is required for this measure. A simple average, which is the sum of the performance rates divided by the number of the performance rates will be used to calculate performance.

For purposes of MIPS implementation, this procedure measure is to be submitted each time a denominator eligible procedure is performed during the denominator identification period. This is an inverse measure which means a lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control.

Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures, a rate of 100% means all of the denominator eligible patients did not receive the appropriate care or were not in proper control.

Measure Details

MIPS 432View CMS Spec ↗
Year2026
TypeOutcome
PriorityHigh Priority
InverseYes
Topped OutNo
7-Point CapNo
SubmissionMIPS CQM

Specialty Sets

CMS-designated specialty sets containing this measure:

Obstetrics/Gynecology (23)Urology (21)

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Official Resources

📄 CMS Measure Specification (PDF)🔗 QPP Quality Payment Program

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