Thank you for your inquiry regarding CMS826v3, Hospital Harm - Pressure Injury. This measure assesses the proportion of all inpatient hospitalizations for patients age 18 and older who suffer the harm of developing a new stage 2, stage 3, stage 4, deep tissue, or unstageable pressure injury. Each inpatient hospitalization period assessed by this measure includes time in the emergency department (ED) and/or in observation status when the transition between discharge from these encounters (if they exist) and admission to the inpatient encounter is one hour or less. Stage 2, 3, 4, and unstageable pressure injuries that result from pressure events preceding hospital care should be visible during the initial skin exam performed within the first 24 hours of a patient's hospitalization. Therefore, the measure's numerator looks for the diagnosis of a new stage 2, 3, 4, or unstageable pressure injury found by skin exam after the first 24 hours of the inpatient hospitalization to identify only stage 2, 3, 4, and unstageable pressure injuries that result from precipitating pressure events that occur during the hospitalization period. In the scenario you provided, because the patient did not have ED or observation encounter immediately preceding the inpatient admission, the inpatient hospitalization period assessed by this measure starts at inpatient admission. And because the patient's stage 2 pressure injury was identified 36 hours after inpatient admission, the inpatient hospitalization for this patient would meet the measure's numerator criteria since a stage 2 pressure injury was found on exam greater than 24 hours after the start of the encounter.