We have several cases in which patients did not have a STEMI during the ED encounter but are being pulled into the IPP/denominator by the patients final ICD-10 coding of STEMI. In these cases, the STEMI occurred after admission or was final coded with an ICD-10 code of STEMI for a history of a STEMI w/in the 4 weeks prior.  Our coding and CDI managers advised us the following scenarios must be coded as STEMI POA Y.

• NSTEMI in ED that evolves to a STEMI after the patient is admitted.
• STEMI occurring after admission. Initial EKG did not show STEMI, but because the cardiac Cath showed a thrombosis of a previous stent w/in the first 72 hrs. the STEMI must be final coded as present on admission.
• history of acute STEMIs w/in the prior 4 weeks 

These patients did not have a STEMI in the ED encounter but are not excluded from the measure.  Can you confirm that in the absence of STEMI documented in the ED encounter that a final ICD-10 diagnosis code of STEMI qualifies a patient for the IPP/denominator? And if so, how can these cases be excluded as they do not reflect the intent of the measure.