For measure 60, NQF0164, in the first part of the denominator, it has:

Denominator =
AND: "Initial Patient Population"
AND:
AND: FIRST:"Occurrence A of Diagnostic Study, Result: Hospital Measures-ECG" during
OR: "Occurrence A of Encounter, Performed: Hospital Measures-Encounter Inpatient"
OR: "Occurrence A of Encounter, Performed: Hospital Measures-Encounter ED" <= 1 day(s) starts before start of "Occurrence A of Encounter, Performed: Hospital Measures-Encounter Inpatient"
AND:
OR: "Occurrence A of Diagnostic Study, Result: Hospital Measures-ECG (result: 'Hospital Measures-ST-segment elevation')"
OR: "Occurrence A of Diagnostic Study, Result: Hospital Measures-ECG (result: 'Hospital Measures - Acute or Evolving MI')"
OR: "Occurrence A of Diagnostic Study, Result: Hospital Measures-ECG (result: 'Hospital Measures-LBBB')"
In the specifications, for the attribute about acute or evolving MI, it has this listed as the criteria:
Attribute: "Result: Hospital Measures-Acute or Evolving MI" using "Hospital Measures-Acute or Evolving MI Grouping Value Set (2.16.840.1.113883.3.666.5.3022)"

However, in the QRDA Cat 1 file for the patient, if you look at the value element below, the only way to know that it is acute or evolving MI is by the text. The *.3022 code for that attribute is nowhere in the file. So my question is: How can we determine the presence of an attribute?

Below is the section of the QRDA Cat 1 patient data file in question.

<entry>
<observation classCode="OBS" moodCode="EVN" >
<!-- Consolidated Result Observation templateId (Implied Template) -->
<templateId root="2.16.840.1.113883.10.20.22.4.2"/>
<!-- Diagnostic Study, Result template -->
<templateId root="2.16.840.1.113883.10.20.24.3.20"/>
<id root="1.3.6.1.4.1.115" extension="51a647876debeaf8d1000010"/>
<code code="8601-7" codeSystem="2.16.840.1.113883.6.1" xsi:type="CD" sdtc:valueSet="2.16.840.1.113883.3.666.5.3018"><originalText>Diagnostic Study, Result: Hospital Measures-ECG Impression (Code List: 2.16.840.1.113883.3.666.5.3018)</originalText></code>
<text>Diagnostic Study, Result: Hospital Measures-ECG Impression (Code List: 2.16.840.1.113883.3.666.5.3018)</text>
<statusCode code="completed"/>

<effectiveTime>
<low value='20120430131000'/>
<high value='20120430131000'/>
</effectiveTime>
<value code="10273003" codeSystem="2.16.840.1.113883.6.96" xsi:type="CD"><originalText>Hospital Measures-Acute or Evolving MI</originalText><translation code="410.00" codeSystem="2.16.840.1.113883.6.103"/>
<translation code="I21.01" codeSystem="2.16.840.1.113883.6.90"/>
</value>

</observation>
</entry>