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