Thank you for your inquiry for CMS996v4: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). Our understanding of your question is that you are seeking information on whether the timing of aspiration thrombectomy for STEMI patients (“aspiration on”) meets the measure’s numerator requirements and seeking clarification on whether “wire crossing lesion” is equivalent to “interventional guidewire insertion time” for the purpose of identifying the PCI intervention timing. The CMS996v4 measure’s PCI definition does include aspiration thrombectomy. The measure captures the PCI procedure using the relevant clinical codes found in the ‘Percutaneous Coronary Intervention’ value set. Specifically, the codes related to “extirpation of matter from coronary artery” relate to aspiration. Details about the PCI value set can be found here on the Value Set Authority Center (VSAC): https://vsac.nlm.nih.gov/ The measure captures the time from ED arrival to PCI procedure, and the goal of the treatment is reperfusion. Ideally, the appropriate PCI treatment timing is documented in the EHR as the time of balloon inflation. The balloon inflation time is often documented in the cardiac catheterization procedural and nursing notes. In the absence of the balloon inflation time, other procedural elements that demonstrate reperfusion of the vessel may also be used (i.e., dilation of coronary artery, stent placement, etc.). Regarding the second question about “wire crossing lesion”, we can confirm that is related to interventional guidewire insertion time. This part of the procedure involves insertion of the guidewire to cross the lesion for further intervention and revascularization.