Thank you for your inquiry regarding CMS0996v5 Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). We understand the intent of your first inquiry is to determine whether a patient that was transferred from an Emergency Department (ED) to an acute care hospital, where the STEMI diagnosis occurred after the ED encounter, is captured in the STEMI measure numerator for the acute care hospital. Only ED encounters with STEMIs occurring during the ED encounter will be included in the measure denominator and subsequently considered for inclusion in the numerator. To determine if a STEMI diagnosis occurred during an ED encounter, the measure looks for (i) a STEMI diagnosis from the ED encounter diagnosis list or (ii) a STEMI diagnosis in a patient’s problem list, claims data, or other sources that the EHR vendor has mapped to the QDM diagnosis data type with the prevalence period starting during an ED encounter. Therefore, the timestamps of the diagnosis’s prevalence period and the ED encounter’s start and end must be accurately documented. In response to your second inquiry, the specifications state that the initial population includes ‘all emergency department encounters for patients 18 years and older at the start of the encounter with a diagnosis of ST-segment elevation myocardial infarction (STEMI) during an Emergency Department encounter that ends during the measurement period.’ So, the patient’s inclusion in the measure denominator is based on the ED encounter, rather than the inpatient encounter or population. We agree that, in addition to the initial population criteria, patients are excluded from the denominator if they meet the conditions outlined in the ‘Denominator Exclusions’ and ‘Denominator Exceptions’ in the measure specifications. These definitions can be found in the measure’s HTML file posted on the eCQI Resource Center [ https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS996v5.html ]. In addition, please refer to the updated Version 6 STEMI measure specifications for the 2026 reporting period, which is now available on the eCQI Resource Center: [ https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS996v5.html ].

Patient came in for specific hospital with No STEMI in ED but chest pain only. Transferred out of the facility to another acute care hospital within the system assigned with different account number and undergo PCI. Will it fall on the numerator. Question #2 This is an episode-based measure, so all ED encounters with STEMI diagnosis, and 18 y/o above must be in the Inpatient population and exclude elements as specified by specs.