Thank you for this question. After further investigation, we have confirmed we may need to modify the specifications as you noted. We will look further into the possibility of remodeled as an encounter diagnosis that is an attribute of the Encounter, Performed datatype. This will remove the timing relationship, and identify that this diagnosis code is included in this encounter. This will be implemented in the next cycle for AU 2019.

Z92.82 (Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility) was added to the eCQM value set evaluated within eMeasure STK-72. However, this code was added to the procedure performed value set. Note, the associated code system is ICD10CM which represents diagnosis. Please consider updating the specification to evaluate this as a diagnosis vs. procedure. As this will not be coded as a procedure. Also, please consider modifying the timing criteria associated with this diagnosis to occur during the inpatient encounter. Even though this code represents the administration of a medication prior to the encounter, the diagnosis code will be applied during the inpatient encounter.

​The code Z92.82 (Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility) was added to 2.16.840.1.113762.1.4.1045.21. However, this code is a ICD10CM which represents Diagnosis, but is currently mapped as a Procedure.

​We are proposing to add t-PA administered prior to arrival as a Denominator Exclusion. This would entail: 1. Ungrouping value set 2.16.840.1.113762.1.4.1045.21 2. Updating the value set 2.16.840.1.113762.1.4.1110.21 by re-naming to t-PA Administered Prior to Arrival, and map code as an attribute or datatype. Proposed Logic in red : It's currently modeled as an attribute of the encounter, or should it be modeled Diagnosis datatype? If so, what timing should be associated with it? Denominator Exclusions "Encounter Less Than Two Days"        union "Encounter with Thrombolytic Therapy Medication or Procedures"        union "Encounter with Thrombolytic Medication"        union "Encounter with Comfort Measures" union “Encounter with t-PA Administered Prior to Arrival   Encounter with t-PA Administered Prior to Arrival TJC."Ischemic Stroke Encounter" IschemicStrokeEncounter Where exists (IschemicStrokeEncounter.diagnosis Diagnosis Where Diagnosis in “ t-PA Administered Prior to Arrival”)    Rationale: To improve the logic and data flow of the measure