Thank you for your inquiry regarding CMS826v3, Hospital Harm - Pressure Injury. Regarding your first question: If a patient has a deep tissue pressure injury or stage 2, 3, 4, or unstageable pressure injury present on admission (identified either by Present on Admission (POA) indicators or skin exam), then the patient's hospitalization will meet the denominator exclusion criteria and will not be included in the measure calculation. Because this inpatient hospitalization would be excluded from the measure's denominator, the progression of this pressure injury and/or any new pressure injuries that the patient develops later in the hospitalization (either at the original pressure injury site or another site) would not qualify the patient's hospitalization for the measure's numerator. However, if the patient had a stage 1 pressure injury present on admission that worsens to a stage 2 during the hospitalization period, the inpatient hospitalization for this patient may meet the numerator criteria, as this would be considered a new stage 2 pressure injury. Inpatient hospitalizations for patients with a stage 1 pressure injury present on admission are not excluded from the measure's denominator. So, in the example you provided, because the patient has a stage 2 pressure injury with a POA indicator of "Y", then the inpatient hospitalization for this patient would be excluded from the measure's denominator, meaning that the inpatient hospitalization would not qualify for the measure's numerator. Regarding your second question: The measure uses codes from the following value sets to identify diagnoses or findings of stage 2, 3, 4, deep tissue, and unstageable pressure injuries: · "Pressure Injury Deep Tissue" (2.16.840.1.113762.1.4.1147.112) · "Pressure Injury Deep Tissue Diagnoses" (2.16.840.1.113762.1.4.1147.194) · "Pressure Injury Stage 2, 3, 4 or Unstageable" (2.16.840.1.113762.1.4.1147.113) · "Pressure Injury Stage 2, 3, 4, or Unstageable Diagnoses" (2.16.840.1.113762.1.4.1147.196) These four value sets include SNOMED CT, LOINC, and ICD-10-CM codes. The measure identifies any pressure injury diagnosis with a SNOMED CT, LOINC, or ICD-10-CM code that is contained in one of those four value sets. The measure does not prioritize a pressure injury diagnosis coded with one code system over another pressure injury diagnosis coded with a different code system. More information on the codes contained in these value sets can be found on the Value Set Authority Center (vsac.nlm.nih.gov).