1. What should we do when visual acuity might be recorded as right or left specific SNOMED code? What if right is different from left? Which do we use? Response: This measure specification does not specifically relate the laterality of the procedure with the laterality of the visual acuity finding. Because some clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but ICD-9-CM and SNOMED-CT do not uniformly include this distinction), it is not a requirement of this measure to indicate laterality of visual acuity. Our understanding is that this procedure is usually conducted one eye at a time, and would anticipate that the clinical documentation of laterality would be included in the patient’s record, but it is not a reporting requirement per the specification. This measure is expected to be reported for each procedure performed – so if a patient has a right eye procedure May 1st, and a second procedure on the left eye 6/1, they would be separately reportable events. 2. What happens if “423364005 Distance Vision 20/25” is recorded as it is better than 20/40, but not included in the value set? Response: We agree that “423364005 Distance Vision 20/25” meets the intent of the numerator, but at this time is not included in the value set. We recommend implementers map locally captured clinical concepts (assuming they meet the intent of the data element 'Visual acuity better than 20/40') to the concepts included in the value set. We have recently completed the annual update cycle for the 2015 posting, but will consider this concept for inclusion in the value set during the next annual update cycle.