Thank you for your question about CMS1028 Severe Obstetric Complications (SOC). The numerator exclusions are "Inpatient hospitalizations with blood transfusion or hysterectomy with a diagnosis of placenta percreta or placenta increta and no additional severe obstetric complications" for the numerator population of all SOCs as well as for the numerator population with SOCs excluding encounters where blood transfusion was the only SOC. A pre-existing condition of acute heart failure that is coded as present on admission would not be a numerator exclusion. It would also not be considered a severe obstetric complication to qualify for the numerator.   As seen in the "Delivery Encounters with Severe Obstetric Complications Diagnosis or Procedure Excluding Blood Transfusion" definition, the Severe Maternal Morbidity Diagnoses listed in your question would be considered SOC for the qualifying encounters if those diagnoses were not present on admission or unable to be determined (UTD) present on admission. For the listed Severe Maternal Morbidity Procedures, they must start during a day of the qualifying encounter.