Thank you for your inquiry regarding CMS996v6: Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED). The denominator exclusion for "Active Bleeding or Bleeding Diathesis, Excluding Menses", is met when a qualifying diagnosis is recorded at the start of the ED encounter. Qualifying diagnoses can be found on the Value Set Authority Center ( https://vsac.nlm.nih.gov/ ) using OID: 2.16.840.1.113883.3.3157.4036. The value set specifies active bleeding diagnoses (e.g., active GI bleed) and macular edema, ocular conditions, hypertension, hyperlipidemia, and anti-VEGF injections are not included in this value set.   For reference, the CMS996 v6.3.000 measure logic defining Active Exclusion Diagnosis At Start of ED Encounter is included below. This logic is also available on the eCQI Resource Center: [ https://ecqi.healthit.gov/sites/default/files/ecqm/measures/CMS996-v6.3.000-QDM.html ]: 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. This case could, however, qualify for a denominator exception under the “ED Encounter With A Documented Reason For Not Administering Fibrinolytic Therapy Within 30 Minutes Of ED Arrival” criterion based on the statement that the ocular pathology and recent anti-VEGF administration is a contraindication for fibrinolytics. The definition for this exception is as follows: ED Encounter With A Documented Reason For Not Administering Fibrinolytic Therapy Within 30 Minutes Of ED Arrival   "ED Encounter With STEMI Diagnosis" EDwSTEMI     with (["Medication, Not Administered": "Fibrinolytic Therapy"] NoFibrinolytic           where (NoFibrinolytic.negationRationale in "Patient Refusal" or NoFibrinolytic.negationRationale in "Drug Intervention Not Indicated/Contraindicated")) FibrinolyticRefused     such that FibrinolyticRefused.authorDatetime during EDwSTEMI.relevantPeriod   In order for the measure logic to recognize this exception, the "not administered" reason has to exist as a coded data element and not just as free text in the ED notes – i.e., a "Medication, Not Administered" entry with a “negationRationale” code from the "Drug Intervention Not Indicated/Contraindicated" value set (OID:2.16.840.1.113762.1.4.1282.1). [For follow-up questions submitted more than 30 days after the "Solution Posted On" date, please submit a new Jira ticket.]