Thank you for your inquiry regarding CMS996, Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED) measure. Please note that this response treats the scenario described as comprising of two ED encounters. The first ED encounter occurs in the facility without a cath lab and ends when the patient is discharged and departs the facility by air. The second ED encounter begins when the patient arrives to the ED of hospital with interventional capabilities. The measure excludes ED encounters where a patient experienced cardiopulmonary arrest either 24 hours or less before the start of ED encounter or during the ED encounter, as indicated by the measure logic definition found in the measure’s HTML file posted on the eCQI Resource Center [ https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS996-v6.3.000-QDM.html ]. Exclusion Diagnosis During ED Encounter Or Within 24 Hours Of ED Encounter Start   "ED Encounter With STEMI Diagnosis" EDwSTEMI   with ( ["Diagnosis": "Aortic Dissection or Ruptured Aortic Aneurysm"]       union ["Diagnosis": "Neurologic impairment"]       union ["Diagnosis": "Cardiopulmonary Emergency"]       union ["Diagnosis": "Angina pectoris with documented spasm"]       union ["Diagnosis": "Ventricular aneurysm due to and following acute myocardial infarction (disorder)"]       union ["Diagnosis": "Aneurysm of heart"]       union ["Diagnosis": "Takotsubo cardiomyopathy (disorder)"]       union ["Diagnosis": "Takotsubo syndrome"]       ) ExclusionDx       such that ( ExclusionDx.prevalencePeriod starts during EDwSTEMI.relevantPeriod           or ExclusionDx.prevalencePeriod starts 24 hours or less before start of EDwSTEMI.relevantPeriod       ) PrevalencePeriod is an attribute of the “Diagnosis” datatype and signifies the onset dateTime to abatement dateTime of the excluded diagnoses, in this case, "Cardiopulmonary Emergency". RelevantPeriod is an attribute of the “Encounter, Performed”: “Emergency Department Evaluation and Management Visit” datatype and signifies the startTime that the encounter began (admission time) to the stopTime that the encounter ended (discharge time). If the cardiac arrest that occurred during transfer is coded using any of the diagnosis codes included in the “Cardiopulmonary Emergency” value set (OID: 2.16.840.1.113883.3.3157.4048) value set, the second ED encounter would be excluded from the measure, as the cardiac arrest occurred within 24 hours or less before the patient arrived to the ED of hospital with interventional capabilities. On the other hand, the first ED encounter would not be excluded, as the cardiac arrest occurred after the encounter ended. However, since the patient was transferred, the first ED encounter could meet the third numerator criterion if the patient was discharged to an acute care facility within 45 minutes of ED arrival.