Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). The intent of your question is to determine whether a STEMI patient that arrives in the ED and has an inpatient order to admit the patient prior to the cath lab or PCI procedure would count towards the measure numerator. The measure captures three potential numerators for patients that arrive to the ED with a STEMI diagnoses: fibrinolytic therapy within 30 minutes, PCI procedure within 90 minutes, or discharge to acute care facility within 45 minutes. In the scenario that you outlined, patients are first discharged from the ED into inpatient care, and then receive the PCI. Discharging the patient from the ED to an acute setting within 45 minutes can count towards the numerator as one of the three possible numerator outcomes. In this numerator, a patient will need a disposition plan from the ED and may go on to an acute setting (either on-site or at another setting) to receive further diagnostic or treatment services. In the scenario described, the patient would count under the third numerator, if documented accordingly in the EHR.