Thank you for your question. For the April 1 annual update, the release notes and guidance were updated to match the language changes for denominator exclusions found in the specification. While the previous language of the specification stated, “Patients who had a suprapubic catheter or had intermittent catheterization preoperatively”, this language was not continued in the updated specification. The previous language of the specification also expressed the following as an excluded population: “Patients who had a urethral catheter, a suprapubic catheter or who were being intermittently catheterized prior to the perioperative period.” The updated specification changed the language to express the excluded population as “Patients who had a urinary diversion or a urethral catheter or were being intermittently catheterized prior to hospital arrival”. The specification goes on to further define the urinary catheter and more specifically the urinary diversion as a suprapubic catheter. The steward confirmed that logic expressing the suprapubic catheter in the denominator exclusions should remain. 2) The steward indicates that the measure looks for documentation of insertion and the ‘lack of removal’ by the end of PACU. If the catheter had been inserted and removed prior to the end of PACU, there is no reason to keep the patient in the measure to watch for 2 more days to see whether it was removed or not removed. The logic will be updated during maintenance to further define this intent. Additional response 7/17/13: The measure intent is to exclude the patient based on the timeframe that begins with hospital arrival. The logic will be updated to remove the reference to the surgical procedure that is included currently. 9/18/13 Update The specification asks if there is documentation that an indwelling urethral catheter was placed AND that one was still in place upon discharge from the recovery/post-anesthesia care area. This criterion establishes inclusion in the denominator population. The two logic statements address the placement of the catheter during the specification timeframe, but establish some confusion by not explicitly addressing the presence of the catheter post discharge from the PACU. This modification to the logic language will occur during the maintenance period to make sure the specification requirements are more specifically met. Changing the attribute to removal datetime alone as you suggest would not allow this directive to be met. Your suggestion is appreciated as it spurred further analysis and discussion of the measure with the steward. Thank you, again.