The attached patient has the following real world clinical description: She has an xray ordered and a pregnancy test ordered, which if positive would prevent the xray from being done. The pregnancy test is indeed positive, and the pregnant woman then delivers 7 months later.

This patient being excluded violates the guidance statement of measure 153, "The denominator exclusion does not apply to patients who qualify for the initial patient population based on services other than the pregnancy test alone."

Clinically, this exclusion also does not make sense, she should be screened for chlamydia. as a sexually active patient who is at risk.