The logic in CMS169v3, the current version, the IPP qualifies all patients who are 18 years or older at the start of the measurement period. Denominator: The Denominator limits the IPP to Encounters that occur between the 2nd day of the Measurement period (starts after start of MP start date) [maybe an error in the logic that should be corrected to say “starts concurrent with start of MP”] and 323rd day of the MP. This would account for patients in the denominator who were diagnosed 42 days before the end of the MP and treated on the last day of the MP. AND: "Occurrence A of Encounter, Performed: BH Outpatient encounter" >= 42 day(s) starts before start of "Measurement End Date" AND: "Occurrence A of Encounter, Performed: BH Outpatient encounter" starts after start of "Measurement Start Date" The denominator further limits the patient population to those diagnosed with unipolar or bipolar disorder during that specific occurrence of the Outpatient Encounter. AND: ◦ OR: "Diagnosis, Active: BH Condition Involving Unipolar Depression" ◦ OR: "Diagnosis, Active: BH Condition Involving Bipolar Disorder" starts during "Occurrence A of Encounter, Performed: BH Outpatient encounter" This is further restricted to patients who had one or more of the following events: ◦ OR: "Procedure, Performed: BH Electroconvulsive Therapy" ◦ OR: "Procedure, Order: BH Electroconvulsive Therapy" ◦ OR: "Occurrence A of Medication, Order: BH Antidepressant Medication" ◦ OR: "Medication, Order: BH Mood Stabilizer Medication" ◦ OR: "Procedure, Performed: BH Counseling for Depression" ◦ OR: "Procedure, Order: BH Counseling for Depression" ◦ OR: "Encounter, Order: BH Outpatient Psychotherapy" ◦ OR: "Encounter, Performed: BH Outpatient Psychotherapy" within 42 days of the specific occurrence of the Outpatient Encounter. However, they exclude encounters that were not within 180 days of an active Diagnosis of Unipolar / bipolar depression, an active anti-depression or mood stabilizer medication, and encounters within 180 days during which an active diagnosis was made for unipolar/bipolar depression, and encounters that started within 180 days of: ◦ OR: "Procedure, Performed: BH Electroconvulsive Therapy" ◦ OR: "Procedure, Order: BH Electroconvulsive Therapy" ◦ OR: "Occurrence A of Medication, Order: BH Antidepressant Medication" ◦ OR: "Medication, Order: BH Mood Stabilizer Medication" ◦ OR: "Procedure, Performed: BH Counseling for Depression" ◦ OR: "Procedure, Order: BH Counseling for Depression" ◦ OR: "Encounter, Order: BH Outpatient Psychotherapy" ◦ OR: "Encounter, Performed: BH Outpatient Psychotherapy" …which sounds like what the measure’s header is saying “The existence of a 'new diagnosis' is established by the absence of diagnoses and treatments of unipolar depression or bipolar disorder during the 180 days prior to the diagnosis” Numerator: The numerator includes patients from the denominator who had Assessment for Alcohol or Other Drugs from the Outpatient encounters in the denominator, either after the outpatient encounter or on the same day as the outpatient encounter. It further limits the patients who received this Assessment for Alcohol or other drugs either after or on the same day as the first event of one of the following events: ◦ OR: "Procedure, Performed: BH Electroconvulsive Therapy" ◦ OR: "Procedure, Order: BH Electroconvulsive Therapy" ◦ OR: "Occurrence A of Medication, Order: BH Antidepressant Medication" ◦ OR: "Medication, Order: BH Mood Stabilizer Medication" ◦ OR: "Procedure, Performed: BH Counseling for Depression" ◦ OR: "Procedure, Order: BH Counseling for Depression" ◦ OR: "Encounter, Order: BH Outpatient Psychotherapy" ◦ OR: "Encounter, Performed: BH Outpatient Psychotherapy" But within 42 day(s) of the Outpatient encounter. The numerator says “Patients in the denominator with evidence of an assessment for alcohol or other substance use following or concurrent with the new diagnosis, and prior to or concurrent with the initiation of treatment for that diagnosis”.