Thank you for your follow-up inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). We interpret the intent of the inquiry is to determine why a patient with a D17.79 (Benign lipomatous neoplasm of other sites) ICD-10-CM diagnosis coded as present on admission (POA) was not excluded from the measure denominator. The measure excludes patients with known malignant intracranial neoplasms (primary or metastatic) if the condition starts before the start of the ED encounter and does not end before the ED encounter. The reason the patient was not excluded from the measure denominator is because ICD-10-CM code D17.79 is not captured in the Malignant Intracranial Neoplasm Group value set (OID: 2.16.840.1.113762.1.4.1170.3) that the measure uses for this exclusion. This value set can be found on the Value Set Authority Center (VSAC) [ https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1170.3/expansion/Latest ]. Please note that you may need to create a free account to view these codes. The reason that code D17.79 is not included in the value set is because the measure excludes malignant neoplasms, and code D17.79 indicates a benign neoplasm. The logic in the “Active Exclusion Diagnosis At Start of ED Encounter” definition found in the measure’s HTML file [ https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS996-v6.3.000-QDM.html ] excludes conditions that start before the ED encounter and do not end before the ED encounter, in alignment with how the exclusion is described in the HTML header. Please see the following definition below: Active Exclusion Diagnosis At Start Of ED Encounter   "ED Encounter With STEMI Diagnosis" EDwSTEMI     with ( ["Diagnosis": "Active Bleeding or Bleeding Diathesis, Excluding Menses"]       union ["Diagnosis": "Malignant Intracranial Neoplasm Group"]       union ["Diagnosis": "Cerebral Vascular Lesion"]       union ["Diagnosis": "Dementia and Related Intracranial Pathologies"]       union ["Diagnosis": "Pregnant State"]       union ["Diagnosis": "Allergy to thrombolytics"] ) ActiveExclusionDx       such that ActiveExclusionDx.prevalencePeriod overlaps before EDwSTEMI.relevantPeriod The exclusion definition above shows that the diagnosis prevalencePeriod (or time from diagnosis onset to abatement) “overlaps before” the ED encounter relevantPeriod (or the time the encounter began to the time the encounter ended). Meaning, the patient’s diagnosis needs to start before the ED encounter begins for the encounter to be excluded from the measure denominator. Thank you for pointing out the discrepancy between the exclusion definition name in the HTML file and its logic, the measure developer can consider updating the exclusion definition name in a future annual update.