Patient came in and had a vanishing twin code of O31.13X1 "continuing pregnancy after....".  This code is on table 11.09 and from Joint Commission is an exclusion for PC-02.  With the way the eCQM is built it does not have a catch all for table 11.09 as multiple gestation would be accounted for as far as a "singleton baby".  However during the delivery encounter there was only a "single live birth" since it was a vanishing twin, which is coded and what the eCQM would include in the denominator inclusion.  However it seems, this at one point was still a multiple gestation due to code from above and recognized as a exclusion from table 11.09 from Joint Commission but with the "single birth code"(which also seems to be correct since vanishing twin for the labor encounter) it is still included in the measure.  So it seems the eCQM is picking up inclusion at the delivery with "singleton delivery" but how does it pick up multiple gestation before that in this case and exclude the patient.  This patient is being included in the eCQM but there is a clear exclusion from table 11.09 from Joint commission.   I hope that all makes sense and thanks for your time and a better understanding of this.