Thank you for your inquiry regarding CMS816v4 (Hospital Harm- Severe Hypoglycemia). Specific to your inquiry, detailing a patient encounter with a blood glucose level of 22 mg/dL and a subsequent repeat test within five minutes of 78 mg/dL, it is implied, thus we assume, that a hypoglycemic medication was administered within 24 hours before the start of the severe hypoglycemic event (i.e. the glucose test with a result less than 40 mg/dL). Therefore, if the above is true, this encounter should count as a severe hypoglycemic event and meet the numerator, as there is evidence of (1) an initial glucose test with a result less than 40 mg/dL (result was 22 mg/dL), (2) a hypoglycemic medication was administered within 24 hours before the start of the hypoglycemic event (we assume this based on your inquiry), and (3) there was not subsequent repeat test for glucose with a result greater than 80 mg/dL within five minutes or less from the start of the initial glucose test with a result less than 40 mg/dL (result was 78 mg/dL). As indicated in the ‘Definition’ header section of the measure, “[t]he purpose of the repeat test within 5 minutes is to eliminate false positives that can occur in POC testing.” Currently, the 80 mg/dL cutoff represents a specific threshold used to ensure that only true, sustained episodes of severe hypoglycemia are identified as requiring clinical attention.