Thank you for your question on CMS1028, Severe Obstetric Complications (PC-07). A blood transfusion during the delivery encounter would qualify as a severe obstetric complication, and the patient would be included in the numerator. A pre-existing condition of anemia that is present on admission (POA), such as O99.02 Anemia complicating childbirth, would not affect whether or not the patient is counted in the numerator, but rather be taken into consideration for the risk adjusted rate. The risk variables considered for this measure are clinically relevant patient-level factors. The patient-level risk variables in the numerator that are POA have strong relationships with the measure's outcome. Risk-adjusted scores will be reported for this measure for better comparisons in the analysis of measure results. For more information, please reference the Severe Obstetric Complications Methodology Report ( https://ecqi.healthit.gov/sites/default/files/SevereObstetricComplications%20eCQM_Methodology%20Report%20-%20Dec%202022.pdf ) posted on the eCQI Resource Center ( https://ecqi.healthit.gov/eh-cah?qt-tabs_eh=eh-cah-ecqms&globalyearfilter=2024&global_measure_group=eCQMs ).