We have several cases that are being included in the IPP/Denominator where a patient presented to the Emergency Department, did not have a diagnosis of STEMI during the ED encounter, was admitted and subsequently developed a STEMI days later. 

In one example, the patient presents to the ED on 5/31 at 15:15, and diagnosed with an infection. The patient is moved to an inpatient unit at 19:52. The Admission order is at 20:44. The relevant period for the ED Encounter is 5/31 15:15 - 20:44.

On 6/3, the patient is noted to being having an Acute STEMI and is transferred to another facility at 06:00. Looking in the record, the provider did not note a STEMI diagnosis until 6/3. 

In the QRDA Clinical Data elements, it is showing the STEMI diagnosis value twice, only difference is the Prevalence Period intervals:

1.
Value Set OID 
>2.16.840.1.113883.3.3157.4017
OID Description
>STEMI
Attribute
>Author DateTime
Data Type
>DateTime
Attribute Description
>5/31/23 03:16 PM
Code
>Code
>>[ICD10CM I21.3] STEMI
Prevalence Period
>Interval [DateTime]
>>[5/31/23 03:16 PM, 5/31/23 07:51 PM]
Source INI
>HAR
Source Record
>11472964
Source Item
>610 Line 3
 
2.
Value Set OID 
>2.16.840.1.113883.3.3157.4017
OID Description
>STEMI
Attribute
>Author DateTime
Data Type
>DateTime
Attribute Description
>5/31/23 08:45 PM
Code
>Code
>>[ICD10CM I21.3] STEMI
Prevalence Period
>Interval [DateTime]
>>[5/31/23 08:45 PM, 6/3/23 05:59 AM]
Source INI
>HAR
Source Record
>11472964
Source Item
>610 Line 3
 
 
Is this correct? Should the STEMI diagnosis value appear twice and should the diagnosis be mapped to the start of the ED Encounter/ED encounter relevant period, even though it was not noted at that time?
 
We would expect that this case would not appear in the IPP/denominator as the STEMI diagnosis came 4 days after the ED encounter. Does the measure account for these scenarios in any way?
Thank you.