Hi Cheryl,
Open the Field Explorer > Right-click Running Total fields and set it up in this way:
1) Choose {vwTranJrnlChgs.Patient_Number} as the Field to Summarize
2) Choose Distinct Count as the Sum function
3) Under 'Evaluate' choose 'Use a formula' and use this code:
Count ([vwTranJrnlChgs.Procedure_Code},{vwTranJrnlChgs.Patient_Number}) = 2
4) Reset should be Never
5) Drag and drop this Running Total on the report footer.
-Abhilash