STEMI Exclusion Timeframe for Ischemic Stroke

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    • Type: Hosp Outpt eCQMs - Hospital Outpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Heather Homampour, MSN, RN
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      Thank you for your inquiry regarding CMS996v4 and CMS996v5, Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). We highlight that the measure logic for the ischemic stroke exclusion criterion excludes encounters with ischemic stroke that occur within 90 days before the start of or at the start of the ED encounter. To ensure that the patient described in the inquiry is excluded from the measure denominator, we recommend ensuring that the EHR documents the onset dateTime of the ischemic stroke diagnosis prevalencePeriod as the same time as the start of the ED encounter relevantPeriod (or the time the encounter began/admission time). For more information about the ischemic stroke prevalence period, please see the eCQI Resource Center at the following webpage: https://ecqi.healthit.gov/mcw/2025/ecqm-dataelement/diagnosisischemicstroke.html. For information regarding the list of clinical codes included in the ischemic stroke value set (OID: 2.16.840.1.113883.3.117.1.7.1.247), please see the following value set: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.247/definition. Please note that you may need to create free account to view the codes.
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      Thank you for your inquiry regarding CMS996v4 and CMS996v5, Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). We highlight that the measure logic for the ischemic stroke exclusion criterion excludes encounters with ischemic stroke that occur within 90 days before the start of or at the start of the ED encounter. To ensure that the patient described in the inquiry is excluded from the measure denominator, we recommend ensuring that the EHR documents the onset dateTime of the ischemic stroke diagnosis prevalencePeriod as the same time as the start of the ED encounter relevantPeriod (or the time the encounter began/admission time). For more information about the ischemic stroke prevalence period, please see the eCQI Resource Center at the following webpage: https://ecqi.healthit.gov/mcw/2025/ecqm-dataelement/diagnosisischemicstroke.html . For information regarding the list of clinical codes included in the ischemic stroke value set (OID: 2.16.840.1.113883.3.117.1.7.1.247), please see the following value set: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.117.1.7.1.247/definition . Please note that you may need to create free account to view the codes.
    • CMS0996v5
    • CMS0996v4
    • Patients not meeting Denominator Exclusion due to timeframe.

      We have found an instance where a patient presented with an ischemic stroke. During work up, an EKG was performed and STEMI was identified and diagnosis was added despite no symptoms. We believe this case should be excluded as the STEMI was not the most pressing medical condition for the patient during the ED Encounter.

      Regarding the exclusion of Ischemic Stroke "Within 90 days before start of or at start of ED Encounter" we propose that we change the end of this timeframe to "or during ED Encounter." Unfortunately "severe neurological impairment" codes does not include ischemic stroke or stroke-like symptoms.

            Assignee:
            Augustine Weber
            Reporter:
            Heather Homampour (Inactive)
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              Created:
              Updated:
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