Thank you for your inquiry regarding CMS996v5 and CMS996v6 Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). From what the inquiry describes, we interpret that the patient had an initial ED Encounter, then was discharged from the ED to a subsequent inpatient encounter. From the inquiry, it seems that both of these encounters are being combined, rather than documented in the EHR as two separate encounters. Therefore, we recommend working with your EHR vendor to document the ED encounter and the inpatient encounter separately, and map the ED encounter to the “Encounter, Performed”: “Emergency Department Evaluation and Management Visit” QDM datatype, and the inpatient encounter to the “Encounter, Performed”: “Encounter Inpatient” QDM datatype. Documentation of both of these encounters separately will help ensure that diagnoses occurring during the inpatient encounter are not erroneously pulled into the ED encounter, resulting in denominator exclusions. Additionally, we emphasize that several denominator exclusions utilize the “Diagnosis” QDM datatype. 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. Therefore, we recommend working with your EHR vendor to ensure accurate documentation of diagnosis onset and abatement times to ensure that encounters are not improperly excluded from the measure.