I am asking for clarification regarding the STEMI eCQM.  
We had a patient who suffered a STEMI and was treated at another facility 23 days prior to arrival at our facility. They were on anticoagulation following heart cath and stenting at the other facility and presented to our facility with a GI bleed. They were on Brilinta (ticagrelor) which is not a qualifying anticoagulant (antiplatelet) med in the denominator exclusions. They had no STEMI symptoms, no EKGs supporting STEMI, no Physician documentation of STEMI this admission while being treated for GI bleed. Our coders used the I21.9 code in final coding because the STEMI was within the 4-week window allowed.  
So, we have a patient that has an ICD code for STEMI (23 days ago) that presents to our facility for another reason. We will "fail" the eCQM because it is looking for fibrinolytic or PCI therapy. Both of these therapies were not appropriate for this patient. 
Since it I acceptable to code an encounter with the STEMI code for up to 4 weeks, how do we reconcile this scenario with the eCQM requirements?
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