Thank you for bringing your concern to our attention. The logic for the ‘Psych Visit’ does require a relationship to a diagnosis of either Major Depression or Dysthymia, which is similar to the Office Visit logic. However, the logic for the ‘Psych Visit’ now further specifies that this relationship is directly tied to the encounter (the reason for the visit), not just that the encounter was overlapped by an active diagnosis. For example, a patient has an active diagnosis for Dysthymia at the time of the encounter, but is seen for an unrelated problem. The rationale for using the Principal Diagnosis for the Psychiatric visit (encounter) has been because patients seen in psychiatry setting may have more serious (not comparable) primary psychiatric conditions with underlying or secondary depression. It was determined by the measure development workgroup that in this setting only, major depression or dysthymia needed to be the primary diagnosis for the patient. Recent QDM updates have allowed us to directly tie the diagnosis to the encounter using the diagnosis attribute for the encounter. This requires that the listed diagnosis is what the patient was being seen for at this encounter.