Thank you for your question about CMS1028v3 / PC-07 Severe Obstetric Complications (SOCs). Yes, one patient can be in both numerators. There are two performance rate calculations for this measure from the same initial population, with the same denominator and denominator exclusions.   For the examples given, the patient with J96.01 acute respiratory failure with hypoxia would be in both numerators if it is a diagnosis that was not present on admission and as the only SOC, it is it not a blood transfusion. The patient in which the only SOC was a blood transfusion during the delivery encounter, would be included in numerator 1 but in numerator 2, since it is the only SOC.   For the third patient provided, the inclusion of the word "chronic" gives me pause. Pulmonary edema diagnosed during the delivery encounter and NOT present on admission would be an SOC, and together with the blood transfusion would qualify for both numerator 1 & numerator 2. However, chronic pulmonary edema present-on-admission, pulmonary hypertension present-on-admission, or acute or chronic diastolic (congestive) heart failure present on admission would NOT be an SOC, but potentially a risk adjustment variable. If the diagnosis was present on admission for the delivery encounter, then the patient would only be in numerator 1 and not numerator 2 with the blood transfusion being the only SOC. Please also see the attached table.