Thank you for your inquiry regarding CMS996: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). We understand the intent of your inquiry as seeking clarification on (i) why performing emergent CABG (Coronary Artery Bypass Grafting) surgeries when coronary findings yielded a higher level of intervention and PCI is not indicated is not excluded from the measure and (ii) how to account for mechanical circulatory assist device placement occurring in the cath lab prior to the PCI. Regarding the first question, the updated Version 6 STEMI measure specifications for the 2026 reporting period have denominator exceptions for ED encounters with a documented reason (such as not indicated) for (i) not administering fibrinolytic therapy within 30 minutes of ED arrival or (ii) not performing a PCI within 90 minutes of ED arrival. ED encounters with a documented reason for not administering fibrinolytic therapy or not performing a PCI within the abovementioned timeframes are still included in the measure; however, providers are not penalized for not meeting the numerator requirements. Please note that the reason for not performing PCI must be documented during the ED encounter. The updated measure specifications are available in the eCQI Resource Center: [ https://ecqi.healthit.gov/ecqm/hosp-outpt/2026/cms0996v6?qt-tabs_measure=measure-information ]. Reasons for not performing a PCI are captured using the “Procedure, Not Performed” data type together with the Patient Refusal” (OID: 2.16.840.1.113883.3.117.1.7.1.93) and “Procedure Not Indicated/Contraindicated" (OID: 2.16.840.1.113762.1.4.1282.2) value sets. The value sets cover scenarios where a PCI is not indicated or appropriate. These value sets can be found in the Value Set Authority Center (VSAC) by searching each value set’s OID [ https://vsac.nlm.nih.gov/welcome ]. Please note that you may need to create a free account to view these codes. Regarding the second question, please note that a patient’s ED encounter should end when there are changes in patient disposition to another level of care (i.e., inpatient) or when they are discharged from the ED. The end of the ED encounter is not impacted by transfers to other locations (e.g., cath lab) unless the patient disposition changes to another level of care beforehand. The QDM v5.6 ( https://ecqi.healthit.gov/sites/default/files/QDM-v5.6-508.pdf ) similarly describes an ED encounter as the following: “by convention, an Encounter, Performed start and stop times reference the admission and discharge times”. Therefore, mechanical circulatory assist device placement in the cath lab before PCI is considered as occurring during the ED encounter, and would meet the mechanical circulatory assist device placement denominator exclusion criteria.

Patient is appearing in eCQM submission data as being included in the denominator and not as an exclusion, resulting in this case failing the OP-40 STEMI measure. We are requesting clarification why this case would not qualify as an exclusion as the coronary findings yielded a higher level of intervention with CABG surgery, and a PCI was not indicated. Case details below.