OP-40 will count any patient from ED that has a diagnosis of STEMI, it does not take into account if the patient develops a STEMI on subsequent EKGs. If a patient presents to ED and does not have a STEMI, but develops one an hour later and is diagnosed with STEMI at this time, we will automatically fall out on this measure because CMS is using the time of arrival to capture the thrombolytics and / or transfer times.