When validating the CMS 2 measure for depression screening, a question came up regarding which depression screening to use for when a patient is 17 at the start of the measurement period and has more than one depression screening with one being an adolescent screening administered when the patient is 17 and an adult screening administered when the patient is 18.  

The eCQM measure flow and the measure description text indicate that the most recent depression screening should be used.  But the measure logic indicates the following should be used with OR logic:  

( "Patient Age 17 Years at Start of Measurement Period"      and ( "Has Most Recent Adolescent Screening Negative"          or exists "Most Recent Adolescent Depression Screening Positive and Follow Up Provided"          or "Has Most Recent Adult Screening Negative"          or exists "Most Recent Adult Depression Screening Positive and Follow Up Provided"      )
What should the outcome be for the following scenarios:   1.  Patient has an eligible visit with a 99384 visit code for a Well Child visit with a negative adolescent screening (PHQ M) both on 2/7/20XX when they are 17.  They come back later in the year after their 18th birthday in July and have a positive adult depression screening (PHQ 9) with no follow up and a 99215 visit code both on 10/7/20XX. 2. Patient has an eligible visit with a 99213 visit code and a positive adolescent screening (PHQ M) with no follow up both on 3/1/20XX at age 17.  They come back later in the year after their 18^th birthday in April. They have a positive adult screening with a PHQ 9 and a follow-up for a positive depression screening with their 99214 office visit on 9/12/20XX. Thank you for your guidance.