Thank you for your question regarding CMS506v7, Safe Use of Opioids - Concurrent Prescribing. Patients with a do-not-resuscitate (DNR) order/status are not included in the palliative or hospice care denominator exclusion. Patients who are ordered or are receiving palliative or hospice care (including comfort measures, terminal care, and dying care) during the hospitalization or in an emergency department encounter or observation stay immediately prior to hospitalization are excluded from the measure. This exclusion is defined in the value set "Hospice Care Referral or Admission" (2.16.840.1.113762.1.4.1116.365) are excluded. This value set includes SNOMEDCT codes for the following: - Urgent admission to hospice (procedure) - Routine admission to hospice (procedure) - Admission to hospice for respite (procedure) - Transition from acute care to hospice (finding) - Transition from home-health care to hospice (finding) - Transition from long-term care to hospice (finding) - Admission to hospice (procedure) - Referral to hospice (procedure) - Hospice care management (procedure) - Discharge to home for hospice care (procedure) - Discharge to healthcare facility for hospice care (procedure) - Home hospice service (qualifier value) - Transition from self-care to hospice (finding) - Transition of care from emergency department to hospice (finding) - Referral to hospice at home service (procedure) Please note: An order for a consult for Palliative or Hospice Care would also meet the requirements for the denominator exclusion, regardless of the outcome of the consultation.