Hello and thanks for taking my question.  We have a main campus that has a cath lab and does PCI's.  We also have another campus that is an ER and other options but does not have capabilities of a patient going to cath lab that is a different location geographically.  We had a patient come to the ER location but then needed to be transferred to our main campus to have PCI.  This patient fell into the OP-40 measure due to STEMI but was in the numerator due to PCI greater than 90min.  Is there any exclusions with this since it is a transfer to different campuses even thought they are within the same organization.  Has this logic been discussed on how to handle this.   Can you please provide me with information on how this is looked at, or if any exclusions would apply in certain cases with transfers but within same organization or logic behind this.  Thanks again for your help and better understanding this-Will