Hello JIRA,

We have questions/ concerns about the exclusion criteria for the outpt STEMI measure.

1^st issue: For the Exclusions using ICD  10 codes for the section “Within 24 hours before start of ED encounter or During ED Encounter”. This seems to impact the timing of the ED Encounter overlapping with the Cath Lab portion of the encounter.

The workflow at hospitals for a status change from “Emergency” (encounter) to “Inpatient” (encounter) relies on an order from the physician / provider.  This is the Date/ time for beginning / end of such patient statuses.  Arrival time and registration of emergency (encounter) is the start of the ED Visit; with the end of ED Visit relying on an inpatient or observation order to change patient status.

There is no mechanism in place for the date/ time of ICD 10 codes to differentiate between ED visit and inpatient/ observation portion of the encounter.

Example of issue:

Ventricular Fibrillation, / Ventricular tachycardia will have the same ICD 10 code even when this occurs during the inpatient / observation period of the encounter.  There is no way to determine a date/ time for this – It can occur from arrival to discharge and be the same.  This is inappropriately excluding patients.

2^nd issue: On Cardiopulmonary arrest: There are at least two codes in question in the value set.    2.16.840.1.113883.3.3157.4048

Postprocedural cardiac arrest following cardiac surgery   197.120

Intraoperative cardiac arrest during cardiac surgery    197.710

Is it the assumption of the measure stewards that patients who have had a cardiac arrest during or after cardiac surgery will then have an ED visit?  This seems unlikely as they may have already been admitted as inpatient or observation patient.

This may capture patients who are actively having a cardiac cath (and the timing as the specs read) may still be in the ED portion of the encounter IF the order for inpatient/ Observation has not been written/entered by the provider.

Regardless – There are no date/ times associated with ICD 10 codes.

We respectfully request the measure stewards discuss the outstanding issues with hospitals with different EMR, Coding experts, and vendors who specialize in capturing this measure data and the actual workflows of hospitals to ensure this measure genuinely reflects what the measure stewards hope to achieve.

Any Advice to correctly capture the desired results is appreciated.