SNOMED#449033003 - Balloon dilation of cardiac conduit (procedure) is contained in value set 2.16.840.1.113883.3.3157.4056 for Major Surgical Procedure. 

Appropriate care would require "Procedure, Performed: Percutaneous Coronary Intervention" within 90 minutes of arrival for non-transfer patients. As  part of the appropriate PCI workflow, we have found some hospital organizations have automated data mapping as part of the balloon angioplasty workflow to SNOMED#449033003.

Because of this automated data mapping, patients who have appropriate care of PCI within 90 minutes of arrival are being  evaluated in the Denominator Exclusion because of the inclusion in the Major Surgical Procedure value set. 

Denominator Exclusion satisfied by Balloon inflation intra-procedure documentation during PCI 

"Major Surgical Procedure 21 Days or Less Before End of ED Encounter"

We would recommend a closer evaluation of the Major Surgical Procedure value set to remove terminologies that could be incidentally documented as part of the PCI workflow. Alternately, the criterion could be moved to the Denominator Exception to allow for appropriate numerator workflows to be captured first.