Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). The measure calculates the percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of STEMI that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or discharge to a PCI-capable acute care facility within 45 minutes of ED arrival. We understand the intent of your question is to confirm whether specific cases meet measure denominator and numerator criteria. Since the events of the first case are documented in the inpatient encounter rather than an ED encounter, the first case will not be captured by the measure. It is the measure’s intent to only capture events occurring in the ED encounter, and not an inpatient encounter. We recommend documenting ED encounters and inpatient encounters separately to ensure appropriate attribution. If the encounter was documented in the EHR as an ED encounter and mapped to the “Encounter, Performed”: “Emergency Department Evaluation and Management Visit” datatype, it would have been captured in both the measure denominator and numerator because the PCI (occurring at 9:30am) was performed within 90 minutes of ED arrival (9am). For the second case, assuming that the ED encounter and inpatient encounters are documented in the EHR separately, this case should be captured by the measure denominator and numerator. If the patient had a PCI within 90 minutes of ED arrival, and was discharged to acute care within 45 minutes of ED arrival, they would only be counted in the numerator once. To indicate that the ED encounter has ended, we recommend proper documentation of both the ED discharge time and the ED discharge disposition of “Discharge to Acute Care Facility.”