In numerous measures, the QRDA 1 produced does not reflect the patient details as displayed in Cypress. Note, this applies to several measures, I've indicated CMS2 and CMS22.

Frequently, the element is included, but the code either does not match the code in the details or is a nullFlavor code. In the case of CMS2, DENEXCEP requires a depression screening, but the QRDA1 files have a nullFlavor code.

As a result, the calculation values do not match what Cypress is expecting. In bundle-2018, we are finding this across several measures in DENEXCEP, not sure if we have seen it in other populations. We tried in both 3.2.2 and 3.2.3 and found the issue, so it appears to be a problem with bundle-2017-26410350.

Alvin Dunn - 6 N Cancer Male

• Assessment performed adult depression screening LOINC 73832-8 - present, nullFlavor code

Margaret Burton - 2 N GP Peds

• Assessment performed adolescent depression screening LOINC 73831-0 - present, nullFlavor code

Attached are PDFs of two patients' details and QRDA1s.