Patients are being evaluated twice for the STEMI eCQM sometimes with different outcomes. A patient arrives in a non-PCI-capable facility with a STEMI dx.  The patient is transferred to a PCI-capable facility greater than 45 minutes after arrival landing them appropriately in the denominator.  The patient arrives at the PCI-capable facility and undergoes a PCI within 90 minutes of arrival, putting them in the numerator for that encounter.  The measure definition says PCI within 90 minutes of ED arrival for non-transferred patients.  It seems as though the transferred patients should only be evaluated for this measure at the initial ED visit and not for their encounter at the PCI-capable facility.  We are seeing many patients being evaluated twice.