Thank you for your inquiry into CMS108v12Venous Thromboembolism Prophylaxis. Please note that the timings of "Low Risk" and "Medical Reasons" are both anytime between the day of arrival and the day after inpatient admission. The following measure definitions align with the measure intent. Low Risk for VTE or Anticoagulant Administered From Day of Start of Hospitalization To Day After Admission No Mechanical VTE Prophylaxis Due to Medical Reason From Day of Start of Hospitalization To Day After Admission The time frame From Day of Start of Hospitalization To Day After Admission includes Emergency Department and Observation Service if ED and OBS are applicable in these cases. This utilizes a ‘Function’ called: Global.HospitalizationWithObservation(Encounter "Encounter, Performed"): Encounter Visit        let ObsVisit: Last(["Encounter, Performed": "Observation Services"] LastObs                                     where LastObs.relevantPeriod ends 1 hour or less on or before start of Visit.relevantPeriod                                     sort by                                     end of relevantPeriod        ),        VisitStart: Coalesce(start of ObsVisit.relevantPeriod, start of Visit.relevantPeriod),        EDVisit: Last(["Encounter, Performed": "Emergency Department Visit"] LastED                                     where LastED.relevantPeriod ends 1 hour or less on or before VisitStart                                     sort by                                     end of relevantPeriod        )        return Interval[Coalesce(start of EDVisit.relevantPeriod, VisitStart),        end of Visit.relevantPeriod] The above measure logic pulls the time from the patients' arrival in the ED or OBS status into the time period for the overall admission. We hope this provides greater clarity.

When patients are admitted through the ED late at night and the admission documentation is started while the patient is in the ED, but the actual admission to the inpatient unit does not occur until early morning next day, some data elements may not count toward the numerator.