The patient presents to the ED with a diagnosis other than STEMI but has an unresolved STEMI on their problem list from months/years earlier.  The patient is being evaluated for appropriate STEMI care for this encounter.  A patient presents to the ED with a diagnosis of STEMI but has an unresolved exclusionary diagnosis on their problem list from months/years earlier so the patient is categorized as a denominator exclusion when they belong in the numerator/denominator category.  Is this the intent of the measure or is our system inaccurately pulling patients into the measure for evaluation?