Detailed Example To Illustrate the QRDA Cat I Bug

Cypress Jira Issue #168

This is the IPP criteria for Measure 155:

The highlighted sections are the problematic ones in this particular measure, but this issue exists in other measures as well. The highlighted sections are considered individual data criteria defined on the measure.

• Initial Patient Population =
  • AND: "Patient Characteristic Birthdate: birth date" >= 3 year(s) starts before start of "Measurement Period"
  • AND: "Patient Characteristic Birthdate: birth date" < 17 year(s) starts before start of "Measurement Period"
  • AND:
    • OR: "Encounter, Performed: Face-to-Face Interaction"
    • OR: "Encounter, Performed: Office Visit"
    • OR: "Encounter, Performed: Preventive Care Services-Individual Counseling"
    • OR: "Encounter, Performed: Preventive Care- Initial Office Visit, 0 to 17"
    • OR: "Encounter, Performed: Preventive Care - Established Office Visit, 0 to 17"
    • OR: "Encounter, Performed: Preventive Care Services - Group Counseling"
    • OR: "Encounter, Performed: Home Healthcare Services"
    • during "Measurement Period"

Cypress Test Data

• Contains Encounter, Performed: HIV Visit with the following two code choices:
  1. CPT: 99202
  2. SNOMED: 185349003

Problem

• The CPT Code matches Encounter, Performed: Office Visit, but the SNOMED Code matches Encounter, Performed: Office Visit AND Encounter, Performed: Face-to-Face Interaction

Error

• When calculating the measures, Cypress matches on both of the criteria and expects to find smoking gun data for both criteria. If the vendor chooses the CPT code, Cypress should only require a match upon the Office Visit. Cypress currently produces an error (false positive) stating that it could not find a Face to Face entry in the Cat I.