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  1. CYPRESS Issue Tracker
  2. CYPRESS-1453

CMS 68v8 patient w/duplicate episodes counting individually

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    • Bug/Issue
    • Resolution: Resolved
    • Moderate

    Description

      When testing CMS 68v8 in Cypress v4.0.0, I find a specific patient (Z9 N BH Adult) appears to have 5 separate episodes of care. But, upon closer inspection, two of the episodes have the same CPT code, date, and start/end times. The only difference I see between the two is the inclusion of a principal diagnosis on one but not the other. Since there is no diagnosis requirement for this measure, our system is seeing these as duplicates to one another and only counts 4 unique episodes for this patient. Cypress is expecting 5 episodes, however.

      Here are the episodes included in this patient's file (#3 and #4 appear to be duplicates):
      1. Encounter, Performed: Preventive Care Services - Established office Visit, 18 and Up
      Code System: CPT 99397
      Relevant Period Start: 2019-01-14 08:00:00 UTC
      Relevant Period End: 2019-01-14 08:30:00 UTC
      Author Date/Time: 2019-01-14T08:00:00+00:00
      Length of Stay: 0 days
      2. Encounter, Performed: Contact or Office Visit
      Code System: CPT 99213
      Relevant Period Start: 2019-02-03 08:00:00 UTC
      Relevant Period End: 2019-02-03 09:00:00 UTC
      Author Date/Time: 2019-02-03T08:00:00+00:00
      Length of Stay: 0 days
      3. Encounter, Performed: Psych Visit - Diagnostic Evaluation
      Code System: CPT 90791
      Relevant Period Start: 2019-06-04 08:00:00 UTC
      Relevant Period End: 2019-06-04 09:00:00 UTC
      Author Date/Time: 2019-06-04T08:00:00+00:00
      Length of Stay: 0 days
      4. Encounter, Performed: Psych Visit - Diagnostic Evaluation
      Code System: CPT 90791
      Relevant Period Start: 2019-06-04 08:00:00 UTC
      Relevant Period End: 2019-06-04 09:00:00 UTC
      Author Date/Time: 2019-06-04T08:00:00+00:00
      Diagnosis: 14183003 (SNOMED-CT)
      Length of Stay: 0 days
      5. Encounter, Performed: Contact or Office Visit
      Code System: CPT 99203
      Relevant Period Start: 2019-07-04 11:00:00 UTC
      Relevant Period End: 2019-07-04 11:30:00 UTC
      Author Date/Time: 2019-07-04T11:00:00+00:00
      Length of Stay: 0 days

      Please advise if this is an error or the rationale for including both encounters as separate episodes. I have attached the html and xml files for the patient (patient name: Justin French - template name: Z9 N BH Adult).

      Thank you,
      Judi

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            dczulada David Czulada
            woodstep67 Judi Dorsey
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