I have recently been reviewing the EC_EH_OQR_CMS 2023 05 04 VSAC report for all eCQMs for EC, EH and OQR and i have a question about the column titled "Purpose: Exclusion Criteria" . This column list a number of values, including one that says "No exclusion". I inquired about this No exclusion value which populates for all major surgical procedure value set OID 2.16.840.1.113883.3.3157.4056 to VSAC. VSAC responded explaining the exclusion criteria as follow. 

Exclusion Criteria - A free text statement that describes what specific concept or code criteria would normally be included, but are specifically excluded by the value set author, including their rationale for exclusions. If the value set author determines there are no identified exclusions, they should populate this field with the text “No exclusions”.

MY understanding of the response is if the field populates No exclusions, it means that there are no identified exclusions and therefore those procedures should not cause a patient to be excluded. This is confusing to me because one of the exclusions for this measure is major surgery within 90 days of the or on the start of the ED encounter, but all the procedures categorized under the major surgical procedure value set OID 2.16.840.1.113883.3.3157.4056 have an exclusion criterion of "No exclusion". So, are the major surgeries an exclusion or not? and why does the VSAC have them labeled as "No exclusion"?