Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). Our understanding is that you are seeking guidance on reporting patients that are transferred from the freestanding ED to the main campus with the same CCN. The measure can handle the case described in the inquiry in different ways depending on how the encounter(s) are documented in the EHR: 1. If encounter at the main hospital is an inpatient encounter, then only the encounter at the freestanding ED would be captured in the measure’s numerator if the patient is discharged to acute care at the main hospital within 45 minutes of the freestanding ED arrival time. In this scenario, the second hospital’s IP encounter would not be captured in the measure denominator since it is the measure’s intent to only capture ED encounters (and that patient was sent directly to main campus’ inpatient admission). 2. If the patient is discharged from the satellite ED and admitted to the main hospital ED, the measure will count these as two separate encounters in the denominator and the first ED encounter could not meet the third numerator criterion: discharge to acute care within 45 minutes of ED arrival. To meet this numerator criterion, the first ED encounter must have a discharge disposition of “Discharge to Acute Care Facility.” Since the encounter at the main hospital is an ED encounter rather than an IP encounter, the patient’s first ED encounter cannot have a discharge disposition of “Discharge to Acute Care Facility” regardless of the time stamp that the transfer occurred. If the end of the first ED encounter was properly documented with an ED discharge time and discharge disposition, the EHR would treat the ED encounter at the main hospital as a separate encounter. In this case, the second ED encounter could potentially meet the measure’s numerator if the patient received fibrinolytic therapy within 30 minutes of the patient’s ED arrival at the second hospital or PCI within 90 minutes of the patient’s ED arrival at the second hospital. 3. Lastly, if the scenario is documented in the EHR as only one ED encounter, then it will use the ED arrival time of the freestanding ED to determine numerator inclusion.