Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED)

Compare Versions of: "Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED)"

The Compare function compares two years of the measure specifications found in the header of the measure's HTML. It does not include a comparison of any information in the body of the HTML, e.g., population criteria, Clinical Quality Language, or value sets.

Strikethrough text highlighted in red indicates information changed from the previous version. Text highlighted in green indicates information updated in the new eCQM version.

Compare 2024 version to

Table Options

Download

Measure Information	2023 Reporting Period	2024 Reporting Period	2025 Reporting Period
Title	Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED)	Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED)	Appropriate Treatment for ST-Segment Elevation Myocardial Infarction (STEMI) Patients in the Emergency Department (ED)
CMS eCQM ID	CMS996v3	CMS996v4	CMS996v5
Short Name	OP-40 (STEMI)	OP-40 (STEMI)
CBE ID*	3613e	3613e	3613e
Measure Steward	Centers for Medicare & Medicaid Services (CMS)	Centers for Medicare & Medicaid Services (CMS)	Centers for Medicare & Medicaid Services (CMS)
Description	Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary... intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival Show more > Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival Show less	Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary... intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival Show more > Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival Show less	Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary... intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival Show more > Percentage of emergency department (ED) encounters for patients 18 years and older with a diagnosis of ST-segment elevation myocardial infarction (STEMI) that received appropriate treatment, defined as fibrinolytic therapy within 30 minutes of ED arrival, percutaneous coronary intervention (PCI) within 90 minutes of ED arrival, or transfer within 45 minutes of ED arrival Show less
Measure Scoring	Proportion measure	Proportion measure	Proportion measure
Measure Type	Process	Process	Process
Stratification	*See CMS996v3.html	None	None
Risk Adjustment	*See CMS996v3.html	None	None
Rationale	*See CMS996v3.html	Studies have shown that delays in the treatment of acute myocardial infarction (AMI) leads to increased risk of in-hospital mortality and morbidity, with nearly two lives per 1,000 patients lost per hour of delay in treatment (Sohlpour & Yusuf, 2014; Fibrinolytic Therapy Trialists’... Collaborative Group, 1994). For patients receiving fibrinolytic therapy, the American Heart Association (AHA) estimates that 65 lives will be saved per 1,000 patients if treatment is administered within the first hour of symptom onset, and 131 lives will be saved per 1,000 patients treated if fibrinolytic therapy is delivered within the first three hours (O’Connor et al., 2010). The total ischemic time—that is, the time from onset of STEMI symptoms to the initiation of some form of reperfusion therapy—is the principal determinant of health outcomes for patients with an AMI, so timely care is essential to minimize disease morbidity and mortality. Primary PCI is the preferred treatment approach, with guidelines recommending initiation of PCI within 120 minutes from first medical contact (O’Gara et al., 2013). In situations where it is unlikely or impossible for a patient to receive primary PCI within the 120-minute timeframe, fibrinolytic therapy may be used for reperfusion and should be rapidly administered to reduce mortality and minimize morbidity; guidelines recommend that fibrinolytic therapy administration occur within 30 minutes of hospital arrival; this may also require rapid transfer for PCI (O’Gara et al., 2013). Implementation of an eCQM addressing appropriateness and effectiveness of care for STEMI patients in the ED has the potential to improve the delivery of care furthering alignment with current clinical practice guidelines, while reducing adverse health outcomes such as mortality, bleeding events, and reinfarction. Use of the proposed eCQM could also reduce burden on facilities currently measured using the chart-abstracted Fibrinolytic Therapy Received within 30 Minutes of ED Arrival (OP-2) measure and broaden the population for which performance scores could be publicly reported. Show more > Studies have shown that delays in the treatment of acute myocardial infarction (AMI) leads to increased risk of in-hospital mortality and morbidity, with nearly two lives per 1,000 patients lost per hour of delay in treatment (Sohlpour & Yusuf, 2014; Fibrinolytic Therapy Trialists’ Collaborative Group, 1994). For patients receiving fibrinolytic therapy, the American Heart Association (AHA) estimates that 65 lives will be saved per 1,000 patients if treatment is administered within the first hour of symptom onset, and 131 lives will be saved per 1,000 patients treated if fibrinolytic therapy is delivered within the first three hours (O’Connor et al., 2010). The total ischemic time—that is, the time from onset of STEMI symptoms to the initiation of some form of reperfusion therapy—is the principal determinant of health outcomes for patients with an AMI, so timely care is essential to minimize disease morbidity and mortality. Primary PCI is the preferred treatment approach, with guidelines recommending initiation of PCI within 120 minutes from first medical contact (O’Gara et al., 2013). In situations where it is unlikely or impossible for a patient to receive primary PCI within the 120-minute timeframe, fibrinolytic therapy may be used for reperfusion and should be rapidly administered to reduce mortality and minimize morbidity; guidelines recommend that fibrinolytic therapy administration occur within 30 minutes of hospital arrival; this may also require rapid transfer for PCI (O’Gara et al., 2013). Implementation of an eCQM addressing appropriateness and effectiveness of care for STEMI patients in the ED has the potential to improve the delivery of care furthering alignment with current clinical practice guidelines, while reducing adverse health outcomes such as mortality, bleeding events, and reinfarction. Use of the proposed eCQM could also reduce burden on facilities currently measured using the chart-abstracted Fibrinolytic Therapy Received within 30 Minutes of ED Arrival (OP-2) measure and broaden the population for which performance scores could be publicly reported. Show less	Studies have shown that delays in the treatment of acute myocardial infarction (AMI) leads to increased risk of in-hospital mortality and morbidity, with nearly two lives per 1,000 patients lost per hour of delay in treatment (Sohlpour & Yusuf, 2014; Fibrinolytic Therapy Trialists’... Collaborative Group, 1994). For patients receiving fibrinolytic therapy, the American Heart Association (AHA) estimates that 65 lives will be saved per 1,000 patients if treatment is administered within the first hour of symptom onset, and 131 lives will be saved per 1,000 patients treated if fibrinolytic therapy is delivered within the first three hours (O’Connor et al., 2010). The total ischemic time—that is, the time from onset of STEMI symptoms to the initiation of some form of reperfusion therapy—is the principal determinant of health outcomes for patients with an AMI, so timely care is essential to minimize disease morbidity and mortality. Primary PCI is the preferred treatment approach, with guidelines recommending initiation of PCI within 120 minutes from first medical contact (O’Gara et al., 2013). In situations where it is unlikely or impossible for a patient to receive primary PCI within the 120-minute timeframe, fibrinolytic therapy may be used for reperfusion and should be rapidly administered to reduce mortality and minimize morbidity; guidelines recommend that fibrinolytic therapy administration occur within 30 minutes of hospital arrival; this may also require rapid transfer for PCI (O’Gara et al., 2013). Implementation of an eCQM addressing appropriateness and effectiveness of care for STEMI patients in the ED has the potential to improve the delivery of care furthering alignment with current clinical practice guidelines, while reducing adverse health outcomes such as mortality, bleeding events, and reinfarction. Use of the proposed eCQM could also reduce burden on facilities currently measured using the chart-abstracted Fibrinolytic Therapy Received within 30 Minutes of ED Arrival (OP-2) measure and broaden the population for which performance scores could be publicly reported. Show more > Studies have shown that delays in the treatment of acute myocardial infarction (AMI) leads to increased risk of in-hospital mortality and morbidity, with nearly two lives per 1,000 patients lost per hour of delay in treatment (Sohlpour & Yusuf, 2014; Fibrinolytic Therapy Trialists’ Collaborative Group, 1994). For patients receiving fibrinolytic therapy, the American Heart Association (AHA) estimates that 65 lives will be saved per 1,000 patients if treatment is administered within the first hour of symptom onset, and 131 lives will be saved per 1,000 patients treated if fibrinolytic therapy is delivered within the first three hours (O’Connor et al., 2010). The total ischemic time—that is, the time from onset of STEMI symptoms to the initiation of some form of reperfusion therapy—is the principal determinant of health outcomes for patients with an AMI, so timely care is essential to minimize disease morbidity and mortality. Primary PCI is the preferred treatment approach, with guidelines recommending initiation of PCI within 120 minutes from first medical contact (O’Gara et al., 2013). In situations where it is unlikely or impossible for a patient to receive primary PCI within the 120-minute timeframe, fibrinolytic therapy may be used for reperfusion and should be rapidly administered to reduce mortality and minimize morbidity; guidelines recommend that fibrinolytic therapy administration occur within 30 minutes of hospital arrival; this may also require rapid transfer for PCI (O’Gara et al., 2013). Implementation of an eCQM addressing appropriateness and effectiveness of care for STEMI patients in the ED has the potential to improve the delivery of care furthering alignment with current clinical practice guidelines, while reducing adverse health outcomes such as mortality, bleeding events, and reinfarction. Use of the proposed eCQM could also reduce burden on facilities currently measured using the chart-abstracted Fibrinolytic Therapy Received within 30 Minutes of ED Arrival (OP-2) measure and broaden the population for which performance scores could be publicly reported. Show less
Clinical Recommendation Statement	*See CMS996v3.html	Primary PCI in STEMI: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - "Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration." - "Primary PCI should be performed in patients with STEMI and... ischemic symptoms of less than 12 hours’ duration who have contraindications to fibrinolytic therapy, irrespective of the time delay from first medical contact." Fibrinolytic Therapy when there is an Anticipated Delay to Performing Primary PCI within 120 Minutes of First Medical Contact: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - "In the absence of contraindications, fibrinolytic therapy should be given to patients with STEMI and onset of ischemic symptoms within the previous 12 hours when it is anticipated that primary PCI cannot be performed within 120 minutes of first medical contact.” Transfer to a PCI-Capable Hospital after Fibrinolytic Therapy: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - Immediate transfer to a PCI-capable hospital for coronary angiography is recommended for suitable patients with STEMI who develop cardiogenic shock or acute severe HF, irrespective of the time delay from MI onset. - Urgent transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who demonstrate evidence of failed reperfusion or reocclusion after fibrinolytic therapy. - Transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who have received fibrinolytic therapy even when hemodynamically stable and with clinical evidence of successful reperfusion. Angiography can be performed as soon as logistically feasible at the receiving hospital, and ideally within 24 hours, but should not be performed within the first 2 to 3 hours after administration of fibrinolytic therapy. Show more > Primary PCI in STEMI: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - "Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration." - "Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration who have contraindications to fibrinolytic therapy, irrespective of the time delay from first medical contact." Fibrinolytic Therapy when there is an Anticipated Delay to Performing Primary PCI within 120 Minutes of First Medical Contact: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - "In the absence of contraindications, fibrinolytic therapy should be given to patients with STEMI and onset of ischemic symptoms within the previous 12 hours when it is anticipated that primary PCI cannot be performed within 120 minutes of first medical contact.” Transfer to a PCI-Capable Hospital after Fibrinolytic Therapy: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - Immediate transfer to a PCI-capable hospital for coronary angiography is recommended for suitable patients with STEMI who develop cardiogenic shock or acute severe HF, irrespective of the time delay from MI onset. - Urgent transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who demonstrate evidence of failed reperfusion or reocclusion after fibrinolytic therapy. - Transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who have received fibrinolytic therapy even when hemodynamically stable and with clinical evidence of successful reperfusion. Angiography can be performed as soon as logistically feasible at the receiving hospital, and ideally within 24 hours, but should not be performed within the first 2 to 3 hours after administration of fibrinolytic therapy. Show less	Primary PCI in STEMI: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - "Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration." - "Primary PCI should be performed in patients with STEMI and... ischemic symptoms of less than 12 hours’ duration who have contraindications to fibrinolytic therapy, irrespective of the time delay from first medical contact." Fibrinolytic Therapy when there is an Anticipated Delay to Performing Primary PCI within 120 Minutes of First Medical Contact: The 2013 American College of Cardiology Foundation (ACCF)/American Heart Association(AHA) clinical practice guideline for the management of STEMI recommends that: - "In the absence of contraindications, fibrinolytic therapy should be given to patients with STEMI and onset of ischemic symptoms within the previous 12 hours when it is anticipated that primary PCI cannot be performed within 120 minutes of first medical contact.” Transfer to a PCI-Capable Hospital after Fibrinolytic Therapy: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - Immediate transfer to a PCI-capable hospital for coronary angiography is recommended for suitable patients with STEMI who develop cardiogenic shock or acute severe heart failure (HF), irrespective of the time delay from MI onset. - Urgent transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who demonstrate evidence of failed reperfusion or reocclusion after fibrinolytic therapy. - Transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who have received fibrinolytic therapy even when hemodynamically stable and with clinical evidence of successful reperfusion. Angiography can be performed as soon as logistically feasible at the receiving hospital, and ideally within 24 hours, but should not be performed within the first 2 to 3 hours after administration of fibrinolytic therapy. Show more > Primary PCI in STEMI: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - "Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration." - "Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours’ duration who have contraindications to fibrinolytic therapy, irrespective of the time delay from first medical contact." Fibrinolytic Therapy when there is an Anticipated Delay to Performing Primary PCI within 120 Minutes of First Medical Contact: The 2013 American College of Cardiology Foundation (ACCF)/American Heart Association(AHA) clinical practice guideline for the management of STEMI recommends that: - "In the absence of contraindications, fibrinolytic therapy should be given to patients with STEMI and onset of ischemic symptoms within the previous 12 hours when it is anticipated that primary PCI cannot be performed within 120 minutes of first medical contact.” Transfer to a PCI-Capable Hospital after Fibrinolytic Therapy: The 2013 ACCF/AHA clinical practice guideline for the management of STEMI recommends that: - Immediate transfer to a PCI-capable hospital for coronary angiography is recommended for suitable patients with STEMI who develop cardiogenic shock or acute severe heart failure (HF), irrespective of the time delay from MI onset. - Urgent transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who demonstrate evidence of failed reperfusion or reocclusion after fibrinolytic therapy. - Transfer to a PCI-capable hospital for coronary angiography is reasonable for patients with STEMI who have received fibrinolytic therapy even when hemodynamically stable and with clinical evidence of successful reperfusion. Angiography can be performed as soon as logistically feasible at the receiving hospital, and ideally within 24 hours, but should not be performed within the first 2 to 3 hours after administration of fibrinolytic therapy. Show less
Improvement Notation	Improvement noted as an increase in the rate	Improvement noted as an increase in the rate	Improvement noted as an increase in the rate
Definition	*See CMS996v3.html	None	None
Guidance	This eCQM is an episode-based measure and should be reported for each instance of an ED encounter during the measurement period for patients with a STEMI. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.	This eCQM is an episode-based measure and should be reported for each instance of an ED encounter during the measurement period for patients with a STEMI. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.	This eCQM is an episode-based measure and should be reported for each instance of an ED encounter during the measurement period for patients with a STEMI. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.
Initial Population	All emergency department encounters for patients 18 years and older at the start of the encounter with a diagnosis of ST-segment elevation myocardial infarction (STEMI) during the measurement period	All emergency department encounters for patients 18 years and older at the start of the encounter with a diagnosis of ST-segment elevation myocardial infarction (STEMI) during an Emergency Department encounter that ends during the measurement period	All emergency department encounters for patients 18 years and older at the start of the encounter with a diagnosis of ST-segment elevation myocardial infarction (STEMI) during an Emergency Department encounter that ends during the measurement period
Denominator	Equals Initial Population	Equals Initial Population	Equals Initial Population
Denominator Exclusions	Patients with the following conditions are excluded from measure denominator: • Expired in the ED • Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplase Within 90 days before start of ED encounter: • Ischemic stroke • Significant facial and/or closed head... trauma • Peptic ulcer • Intracranial or intraspinal surgery Within 21 days before end of ED encounter: • Major surgery Within 24 hours before start of ED encounter and during ED encounter: • Suspected aortic dissection • Severe neurologic impairment • Mechanical circulatory assist device placement, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device • Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation • Cardiopulmonary arrest, including: cardiac arrest, CPR, defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR At the start of ED encounter: • Bleeding or bleeding diathesis (excluding menses) • Known malignant intracranial neoplasm (primary or metastatic) • Known structural cerebral vascular lesion (e.g., AVM) • Advanced dementia • Pregnancy • Active oral anticoagulant therapy Show more > Patients with the following conditions are excluded from measure denominator: • Expired in the ED • Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplase Within 90 days before start of ED encounter: • Ischemic stroke • Significant facial and/or closed head trauma • Peptic ulcer • Intracranial or intraspinal surgery Within 21 days before end of ED encounter: • Major surgery Within 24 hours before start of ED encounter and during ED encounter: • Suspected aortic dissection • Severe neurologic impairment • Mechanical circulatory assist device placement, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device • Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation • Cardiopulmonary arrest, including: cardiac arrest, CPR, defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR At the start of ED encounter: • Bleeding or bleeding diathesis (excluding menses) • Known malignant intracranial neoplasm (primary or metastatic) • Known structural cerebral vascular lesion (e.g., AVM) • Advanced dementia • Pregnancy • Active oral anticoagulant therapy Show less	Patients with the following conditions are excluded from measure denominator: During ED encounter: - Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplase At the start of ED encounter: - Bleeding or bleeding diathesis (excluding menses) - Known malignant... intracranial neoplasm (primary or metastatic) - Known structural cerebral vascular lesion (e.g., arteriovenous malformation) - Advanced dementia - Pregnancy - Active oral anticoagulant therapy Within 24 hours before start of ED encounter or during ED encounter: - Aortic dissection or ruptured aortic aneurysm - Severe neurologic impairment - Mechanical circulatory assist device placement, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device - Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation - Cardiopulmonary arrest, including: cardiac arrest, CPR, defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR Within 21 days before start of or starts during ED encounter: - Major surgery Within 90 days before start of or at start of ED encounter: - Ischemic stroke - Significant facial and/or closed head trauma - Peptic ulcer Within 90 days before start of ED encounter: - Intracranial or intraspinal surgery Expired in the ED Show more > Patients with the following conditions are excluded from measure denominator: During ED encounter: - Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplase At the start of ED encounter: - Bleeding or bleeding diathesis (excluding menses) - Known malignant intracranial neoplasm (primary or metastatic) - Known structural cerebral vascular lesion (e.g., arteriovenous malformation) - Advanced dementia - Pregnancy - Active oral anticoagulant therapy Within 24 hours before start of ED encounter or during ED encounter: - Aortic dissection or ruptured aortic aneurysm - Severe neurologic impairment - Mechanical circulatory assist device placement, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device - Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation - Cardiopulmonary arrest, including: cardiac arrest, CPR, defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR Within 21 days before start of or starts during ED encounter: - Major surgery Within 90 days before start of or at start of ED encounter: - Ischemic stroke - Significant facial and/or closed head trauma - Peptic ulcer Within 90 days before start of ED encounter: - Intracranial or intraspinal surgery Expired in the ED Show less	Patients with the following conditions are excluded from measure denominator: At some point during ED encounter: - Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplase Starts before the start of ED encounter and does not end before ED encounter: - Bleeding... or bleeding diathesis (excluding menses) - Known malignant intracranial neoplasm (primary or metastatic) - Known structural cerebral vascular lesion (e.g., arteriovenous malformation) - Advanced dementia - Pregnancy - Diagnosis of allergy to thrombolytics At the start of ED encounter, or most recent dose within 90 days or less of ED encounter: -Active oral anticoagulant therapy Occurs 24 hours or less before start of ED encounter or during ED encounter: - Aortic dissection or ruptured aortic aneurysm - Severe neurologic impairment - Mechanical circulatory assist device placement, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device - Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation - Cardiopulmonary arrest, including: cardiac arrest, cardiopulmonary resuscitation (CPR), defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR Occurs 21 days or less before start of or starts during ED encounter: - Major surgery Occurs 90 days before start of or at start of ED encounter: - Ischemic stroke - Significant facial and/or closed head trauma - Peptic ulcer Occurs 90 days or less before start of ED encounter: - Intracranial or intraspinal surgery With a discharge disposition of patient expired in the ED Show more > Patients with the following conditions are excluded from measure denominator: At some point during ED encounter: - Allergic reaction to alteplase, streptokinase, anistreplase, tenecteplase, or reteplase Starts before the start of ED encounter and does not end before ED encounter: - Bleeding or bleeding diathesis (excluding menses) - Known malignant intracranial neoplasm (primary or metastatic) - Known structural cerebral vascular lesion (e.g., arteriovenous malformation) - Advanced dementia - Pregnancy - Diagnosis of allergy to thrombolytics At the start of ED encounter, or most recent dose within 90 days or less of ED encounter: -Active oral anticoagulant therapy Occurs 24 hours or less before start of ED encounter or during ED encounter: - Aortic dissection or ruptured aortic aneurysm - Severe neurologic impairment - Mechanical circulatory assist device placement, including: aortic balloon pump, biventricular assist device, intra-aortic balloon, intra-aortic balloon counterpulsation, intra-aortic counterpulsation balloon pump, left ventricular device, percutaneous ventricular assist device, or ventricular assist device - Intubation, including endotracheal intubation, mechanical ventilation, nasotracheal intubation, or orotracheal intubation - Cardiopulmonary arrest, including: cardiac arrest, cardiopulmonary resuscitation (CPR), defibrillation, respiratory arrest, or ventricular fibrillation (V-fib), ventricular tachycardia (VT), or pulseless electrical activity (PEA); or, traumatic or prolonged (>10 minutes) CPR Occurs 21 days or less before start of or starts during ED encounter: - Major surgery Occurs 90 days before start of or at start of ED encounter: - Ischemic stroke - Significant facial and/or closed head trauma - Peptic ulcer Occurs 90 days or less before start of ED encounter: - Intracranial or intraspinal surgery With a discharge disposition of patient expired in the ED Show less
Numerator	Emergency department encounters with a diagnosis of STEMI: - where time from ED arrival to fibrinolysis is 30 minutes or fewer; OR - where PCI is performed within 90 minutes of arrival for non-transfer patients; OR - where the patient is transferred within 45 minutes of ED arrival. ... Show more > Emergency department encounters with a diagnosis of STEMI: - where time from ED arrival to fibrinolysis is 30 minutes or fewer; OR - where PCI is performed within 90 minutes of arrival for non-transfer patients; OR - where the patient is transferred within 45 minutes of ED arrival. Show less	Emergency department encounters with a diagnosis of STEMI: - where time from ED arrival to fibrinolysis is 30 minutes or fewer; OR - where PCI is performed within 90 minutes of arrival for non-transfer patients; OR - where the patient is transferred within 45 minutes of ED arrival ... Show more > Emergency department encounters with a diagnosis of STEMI: - where time from ED arrival to fibrinolysis is 30 minutes or fewer; OR - where PCI is performed within 90 minutes of arrival for non-transfer patients; OR - where the patient is transferred within 45 minutes of ED arrival Show less	Emergency department encounters with a diagnosis of STEMI: - where time from ED arrival to fibrinolysis is 30 minutes or fewer; OR - where PCI is performed within 90 minutes of arrival; OR - where the patient is transferred within 45 minutes of ED arrival
Numerator Exclusions	Not Applicable	Not Applicable	Not Applicable
Denominator Exceptions	None	None	Emergency department encounters where the patient received fibrinolytic therapy at another facility within 24 hours.
Telehealth Eligible	No	No	No
Next Version	CMS996v4	CMS996v5	No Version Available
Previous Version	No Version Available	CMS996v3	CMS996v4

Download XML

Download CSV

Specifications

There are known issues on CMS996v4. See issues EKI-25, EKI-26, and EKI-30 on the ONC eCQM Known Issues Dashboard for details.

Additional Resources for CMS996v4

CMS996v4-TRN.xlsx

Header

Updated grammar, wording, and/or formatting to improve readability and consistency.
Measure Section: Description
Source of Change: Annual Update
Updated copyright.
Measure Section: Copyright
Source of Change: Annual Update
Updated description of Initial Population timing to align with measure logic and intent.
Measure Section: Initial Population
Source of Change: Test Case Review
Updated the Initial Population language to indicate the Emergency Department visits that end during the measurement period are captured in this measure.
Measure Section: Initial Population
Source of Change: ONC Project Tracking System (JIRA): CQM-5380
Updated timing of major surgical procedure denominator exclusion to '21 days or less before start of ED Encounter' to align with other definitions.
Measure Section: Denominator Exclusions
Source of Change: Measure Lead
Updated Denominator Exclusion to clarify aortic dissection or ruptured aortic aneurysm satisfies the exclusion criteria to align with measure intent; suspected aortic dissection is not a valid denominator exclusion.
Measure Section: Denominator Exclusions
Source of Change: Measure Lead
Updated Denominator Exclusion to clarify the diagnosis of ischemic stroke, significant facial and/or closed head trauma, and peptic ulcer may start within 90 days before the start of the ED encounter or at the start of the ED encounter to better align with measure intent.
Measure Section: Denominator Exclusions
Source of Change: ONC Project Tracking System (JIRA): CQM-5803
Added timing to denominator exclusion to align with measure logic to add 'during ED encounter' for allergic reaction to Thrombolytics.
Measure Section: Denominator Exclusions
Source of Change: Test Case Review
Revised the order of denominator exclusions in the measure header and logic for readability and listed the exclusions in the header from earliest to latest.
Measure Section: Denominator Exclusions
Source of Change: Measure Lead

Logic

Updated timing of the 'Emergency Department Evaluation and Management Visti' to require the end of the ED visit occur during the measurement period.
Measure Section: Denominator
Source of Change: ONC Project Tracking System (JIRA): CQM-5380
Updated Denominator Exclusion to clarify the diagnosis of ischemic stroke, significant facial and/or closed head trauma, and peptic ulcer may start within 90 days before the start of the ED encounter or at the start of the ED encounter to better align with measure intent.
Measure Section: Denominator Exclusions
Source of Change: ONC Project Tracking System (JIRA): CQM-5803
Updated logic to exclude patients who have taken oral anticoagulants before the start of ED encounter.
Measure Section: Denominator Exclusions
Source of Change: Test Case Review
Updated timing of major surgical procedure denominator exclusion to '21 days or less before start of ED Encounter' to align with other definitions.
Measure Section: Denominator Exclusions
Source of Change: Measure Lead
Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.
Measure Section: Definitions
Source of Change: Standards/Technical Update

Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

Value set (2.16.840.1.113883.3.3157.4036): Renamed to Active Bleeding Excluding Menses or Bleeding Diathesis based on recommended value set naming conventions.
Measure Section: Terminology
Source of Change: Annual Update
Value set Active Bleeding Excluding Menses or Bleeding Diathesis (2.16.840.1.113883.3.3157.4036): Added 4 ICD-10-CM codes (D68.311, D68.312, S06.347A, S06.348A) based on review by technical experts, SMEs, and/or public feedback. Added 8 ICD-10-CM codes (S06.34AA, S06.35AA, S06.36AA, S06.37AA, S06.38AA, S06.4XAA, S06.5XAA, S06.6XAA) based on terminology update.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Acute Peptic Ulcer (2.16.840.1.113883.3.3157.4031): Deleted 1 ICD-10-CM code (K27.9) based on review by technical experts, SMEs, and/or public feedback. Deleted 16 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set (2.16.840.1.113883.3.3157.4031): Renamed to Acute Peptic Ulcer based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Oral Anticoagulant Medications (2.16.840.1.113883.3.3157.4045): Added 2 RxNorm codes (1992427, 2059015) based on review by technical experts, SMEs, and/or public feedback. Added 7 RxNorm codes (2588062, 2590616, 2590620, 2590623, 2590627, 2590631, 2590635) based on terminology update. Deleted 83 RxNorm codes based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Aortic Dissection or Ruptured Aortic Aneurysm (2.16.840.1.113883.3.3157.4028): Added 7 ICD-10-CM codes (I71.10, I71.11, I71.12, I71.13, I71.50, I71.51, I71.52) based on terminology update. Deleted 2 ICD-10-CM codes (I71.1, I71.5) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set (2.16.840.1.113883.3.3157.4028): Renamed to Aortic Dissection or Ruptured Aortic Aneurysm based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Cardiopulmonary Arrest (2.16.840.1.113883.3.3157.4048): Added 3 ICD-10-CM codes (I47.20, I47.21, I47.29) based on terminology update. Deleted 1 ICD-10-CM code (I47.2) based on terminology update. Deleted 1 SNOMED CT code (429046004) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Cerebral Vascular Lesion (2.16.840.1.113883.3.3157.4025): Added 151 ICD-10-CM codes based on review by technical experts, SMEs, and/or public feedback. Added 265 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback. Deleted 3 SNOMED CT codes (230718007, 24551003, 733927008) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Dementia and Related Intracranial Pathologies (2.16.840.1.113883.3.3157.4043): Added 69 ICD-10-CM codes based on terminology update. Deleted 1 SNOMED CT code (230283005) based on terminology update. Deleted 1 SNOMED CT code (161465002) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set (2.16.840.1.113883.3.3157.4043): Renamed to Dementia and Related Intracranial Pathologies based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set (2.16.840.1.113883.3.464.1003.101.12.1010): Renamed to Emergency Department Evaluation and Management Visit based on recommended value set naming conventions.
Measure Section: Terminology
Source of Change: Annual Update
Value set Fibrinolytic Therapy (2.16.840.1.113883.3.3157.4019): Deleted 54 RxNorm codes based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set (2.16.840.1.113883.3.3157.4052): Renamed to Insertion or Replacement of Mechanical Circulatory Assist Device based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Insertion or Replacement of Mechanical Circulatory Assist Device (2.16.840.1.113883.3.3157.4052): Added 5 CPT codes (33981, 33993, 33982, 33983, 33995) based on review by technical experts, SMEs, and/or public feedback. Deleted 4 CPT codes (0451T, 0452T, 0453T, 0454T) based on terminology update. Deleted 2 CPT codes (1006349, 1029971) based on review by technical experts, SMEs, and/or public feedback. Deleted 14 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Intracranial or Intraspinal surgery (2.16.840.1.113762.1.4.1170.2): Added 1 SNOMED CT code (1201979001) based on terminology update. Deleted 3 SNOMED CT codes (171446006, 244238001, 82443007) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Major Surgical Procedure (2.16.840.1.113883.3.3157.4056): Added 79 SNOMED CT codes based on terminology update. Deleted 5579 SNOMED CT codes based on terminology update. Deleted 18 ICD-10-PCS codes based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Malignant Intracranial Neoplasm Group (2.16.840.1.113762.1.4.1170.3): Deleted 39 ICD-10-CM codes based on review by technical experts, SMEs, and/or public feedback. Deleted 1 SNOMED CT code (189162003) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set (2.16.840.1.113883.3.3157.4045): Renamed to Oral Anticoagulant Medications based on recommended value set naming conventions.
Measure Section: Terminology
Source of Change: Annual Update
Value set Payer (2.16.840.1.114222.4.11.3591): Added 5 SOP codes (1111, 1112, 142, 344, 141) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set (2.16.840.1.113762.1.4.1170.6): Renamed to Thrombolytics Adverse Event based on recommended value set naming conventions.
Measure Section: Terminology
Source of Change: Annual Update
Value set Thrombolytics Adverse Event (2.16.840.1.113762.1.4.1170.6): Added 1 SNOMED CT code (218568007) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead