Cypress 3.1.0 - CMS2v6 - Patient Data for Leah Little.

Diagnosis: Depression Diagnosis
SNOMED-CT: 15639000
Start Time: Jan. 30, 2015 5:30pm
End Time: Mar. 30, 2015 4:30pm

Encounter, Performed: Depression Screening Encounter Codes
SNOMED-CT: 14736009
Start Time: Jan. 25, 2015 4:00pm
End Time: Jan. 25, 2015 5:00pm

Encounter, Performed: Office Visit
CPT 99213
Start Time: Jan. 30, 2015 5:00pm
End Time: Jan 30, 2015 6:00pm

Encounter, Performed: Office Visit
CPT 99213
Start Time: Apr. 30, 2015 4:00pm
End Time: Apr. 30, 2015 5:00pm

Leah Little is expected to appear in the Denominator Exclusions.

Is it because the following records meet the "satisfies all" in the Exclusions logic?

Depression Diagnosis starting on Jan. 30, 2015 5:30pm is before the Office Visit on Apr. 30, 2015 4:00pm
Depression Diagnosis starting on Jan. 30, 2015 5:30pm overlaps the Office Visit on Jan. 30, 2015 5:00pm

The confusion arises because these are two different encounters. Normally, when we see "starts before" and "overlaps" we are talking about the same item being tested. Without the "Occurrence A" qualifier on the Encounter, then we see where it could be any Encounter, however in that case it doesn't make sense to have both, "starts before" and "overlaps". If you do look at the same Encounter in this case, then it changes the result and Leah Little would not be an Exclusion.

The description in the measure is, "Denominator Exclusions - Patients with an active diagnosis for Depression or a diagnosis of Bipolar Disorder." In that case, couldn't it simply be a Depression Diagnosis that "starts before" the encounter?

Thank you for your guidance on this one.