Thank you for your inquiry regarding CMS816v3, Hospital Harm – Severe Hypoglycemia. The measure’s numerator logic is captured in the definition ‘Encounter with Severe Hypoglycemic Harm Event’, which contains the definition for ‘Severe Hypoglycemic Harm Event.’ Nested within is the definition ‘Low Glucose Test Followed By Glucose Test Result Greater Than 80.’ As indicated in the logic below, this definition specifies that the follow-up glucose test time must be 5 minutes or less after the glucose test time. Low Glucose Test Followed By Glucose Test Result Greater Than 80 from  "Denominator" QualifyingEncounter,  "Glucose Test with Result Less Than 40" LowGlucoseTest, ["Laboratory Test, Performed": "Glucose Lab Test Mass Per Volume"] FollowupGlucoseTest let GlucoseTestTime: Global."EarliestOf" ( LowGlucoseTest.relevantDatetime, LowGlucoseTest.relevantPeriod ), FollowupGlucoseTestTime: Global."EarliestOf" ( FollowupGlucoseTest.relevantDatetime FollowupGlucoseTest.relevantPeriod ) where FollowupGlucoseTestTime 5 minutes or less after GlucoseTestTime     and GlucoseTestTime during Global."HospitalizationWithObservation" ( QualifyingEncounter )     and FollowupGlucoseTestTime during Global."HospitalizationWithObservation" ( QualifyingEncounter )     and FollowupGlucoseTest.id !~ LowGlucoseTest.id     and FollowupGlucoseTest.result > 80 'mg/dL' return LowGlucoseTest Therefore, based on the scenario included in your inquiry, since the initial glucose test result of 16 mg/dL (<40 mg/dL) and the follow-up lab result of 169 mg/dL (>80 mg/dL) are documented at the same time (22:32 on Jan 8), the result of 169 mg/dL would not count as a follow-up glucose test result >80 mg/dL. The timestamp of the follow-up test must occur after 22:32 and up to 5 minutes after the initial blood glucose test. Per the measure Guidance, “[t]he measure does not count a severe hypoglycemic event (harm) in the numerator if there is a repeat test for glucose with a result greater than 80 mg/dL within five minutes of this initial low glucose test. The purpose of the repeat test within 5 minutes is to eliminate false positives that can occur in POC testing. The 5-minute timeframe extends from the start of the severe hypoglycemic test to the time of the repeat hypoglycemic test”. The 5-minute timeframe is to verify POC testing, not to confirm laboratory blood glucose testing. The measure developer will consider refinements to the timing of blood glucose testing in a future Annual Update.