In CMS178v3 (NQF 0453, SCIP-INF-9), the Denominator Exclusions definition includes three sets of criteria in which each pair is presumably intended to exclude encounters if both a) medication X was administered within two days after the end of the procedure AND b) the patient was transferred to ICU within two days after the end of the procedure.

• OR:
  • AND: "Medication, Administered: Hospital Measures-Diuretics RxNorm" <= 2 day(s) starts after end of ("Occurrence A of Procedure, Performed: SCIP Major Surgical Procedure" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
  • AND: "Encounter, Performed: Encounter Inpatient (facility location: 'Hospital Measures-ICU Locations')" <= 2 day(s) starts after end of "Occurrence A of Procedure, Performed: SCIP Major Surgical Procedure"
• OR:
  • AND: "Medication, Administered: IV Positive Inotropic and Vasopressor Agents" <= 2 day(s) starts after end of ("Occurrence A of Procedure, Performed: SCIP Major Surgical Procedure" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
  • AND: "Encounter, Performed: Encounter Inpatient (facility location: 'Hospital Measures-ICU Locations')" <= 2 day(s) starts after end of "Occurrence A of Procedure, Performed: SCIP Major Surgical Procedure"
• OR:
  • AND: "Medication, Administered: Paralytic Agents" <= 2 day(s) starts after end of ("Occurrence A of Procedure, Performed: SCIP Major Surgical Procedure" during "Occurrence A of Encounter, Performed: Encounter Inpatient")
  • AND: "Encounter, Performed: Encounter Inpatient (facility location: 'Hospital Measures-ICU Locations')" <= 2 day(s) starts after end of "Occurrence A of Procedure, Performed: SCIP Major Surgical Procedure"

But the second statement in each pair, though specifying the ICU location, does not specify the "facility location arrival datetime". Without such a qualifier, the date comparison uses the admission datetime of the encounter.

For the typical single-encounter scenario, the pair will never be true because it can never be the case that both a) the procedure is during the encounter and b) the encounter starts after the end of the procedure. If, however, the second criterion specifies "facility location arrival datetime", it will be satisfied if the transfer to ICU occurs within two days after the end of the procedure.

Since the second criterion does not specify "Occurrence A" for the encounter, it could be satisfied by a second inpatient encounter, immediately following the first. Lacking the "facility location arrival datetime" qualifier though, it is again looking at the admission datetime, thus matching a subsequent encounter where the admission occurred within two days after the end of the procedure, regardless of how much later the transfer to ICU occurred. That does not match the presumed intent of these exclusion criteria so, again, it appears that the "facility location arrival datetime" qualifier is needed.