Thank you for raising this issue. We understand and appreciate the limitations of relying on timing to determine when diagnoses or procedures are historical. Unfortunately, there is not a straightfoward solution to the problem (described below). We would like the opportunity to discuss this issue further with you and a broader community of vendors and implementers, and have flagged this ticket for future discussion through the Change Review Process (CRP). There are not consistent ways within EHRs or within standards to represent history. For example, there are not "history of" ICD-10 and SNOMED codes we can rely on for these data elements. Therefore, if patient history of these procedures is documented during this encounter, we cannot differentiate whether the intent was to document history or if the condition was present/procedure performed during the encounter. In cases such as this one, the clinical intent is specifically to capture history and not current conditions or procedures. The logic you provide is not from the exclusions, it is actually part of the measure numerator and is used to define cases in which a cesarean birth is performed prior to the onset of labor and in the absence of prior uterine surgeries. If you do not have the ability to capture start times prior to the encounter, you may have more numerator cases than you would expect, as the numerator may include cesarean birth cases where there is missing data for prior uterine surgeries. Some systems allow users to indicate the "active" or "present" status of diagnoses/conditions. This may also be a method to address your workflow concerns above. Thank you for providing this example.

PC-01 Exclusions per testing tool must occur in an encounter PRIOR to the delivery. ◾AND NOT: Union of: ◾"Diagnosis, Resolved: Perforation of Uterus" ◾"Diagnosis, Resolved: Uterine Window" ◾"Diagnosis, Resolved: Uterine Rupture" ◾"Diagnosis, Inactive: Cornual Ectopic Pregnancy" ◾"Procedure, Performed: Classical Cesarean Birth" ◾"Procedure, Performed: Myomectomy" ◾"Procedure, Performed: Transabdominal Cerclage" ◾starts before start of Occurrence A of $EncounterInpatient For patients whose first visit to our hospital is to delivery, how can we document this outside the inpatient encounter. We could add it to OB and/or surgical history, but it would still potentially occur in the current encounter. Is this your intent?