Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). This measure captures the percentage of ED encounters for patients 18 years and older with a diagnosis of STEMI who received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, PCI within 90 minutes of ED arrival, or discharge to a PCI-capable Acute Care Facility within 45 minutes of ED arrival. If the patient described in the inquiry was 18 years or older, had a diagnosis of STEMI during the ED encounter, and did not meet any denominator exclusion criteria, they would be captured in the measure denominator. Only STEMIs occurring during the ED encounter will be captured in the measure denominator. If a STEMI presented during inpatient care outside of the ED encounter, it would not be captured in the measure. We highlight that the QDM does not prescribe the source of diagnosis data in the EHR. Diagnoses may be found in a patient’s problem list, encounter diagnosis list, claims data, or other sources within the EHR. If this patient with the STEMI diagnosis was discharged from the ED to receive acute care within 45 minutes of ED arrival, they would also meet the measure’s third numerator criterion. To indicate that the ED encounter has ended once the patient is discharged from the ED to receive inpatient care, we recommend proper documentation of both the ED discharge time and the ED discharge disposition of “Discharge to Acute Care Facility.”

Depending on whether our vendor is correct about including the STEMI patients who get admitted from the Emergency Department (ED), the OP eSTEMI measure build might need to be changed to an OP and an Inpatient measure instead of just an OP measure. If inpatients are being captured because they came through the ED with a potential STEMI, and then coded as having STEMI on discharge, then that seems like it needs to be a whole other measure.