Thank you for your inquiry. CMS2v7 excludes depression and bipolar diagnoses from the measure denominator as outlined in value sets provided in the measure specification, "Bipolar Diagnosis Grouping Value Set (2.16.840.1.113883.3.600.450)" and "Depression diagnosis Grouping Value Set (2.16.840.1.113883.3.600.145)". The measure also includes denominator exceptions, which include medical reasons for not performing the screening and patient refusal as outlined in the values sets "Medical or Other reason not done SNOMEDCT Value Set (2.16.840.1.113883.3.600.1.1502)" or "Patient Reason refused SNOMEDCT Value Set (2.16.840.1.113883.3.600.791)". A patient who qualifies for the denominator exclusion would be removed from the denominator. Denominator exception criteria is only evaluated if the patient does not meet the numerator criteria. Patients who do not meet numerator criteria and meet denominator exception criteria (e.g. medical reason for not performing a screening) would be removed from the denominator. Please let us know if we can provide further assistance.

CMS2v7; there is a Cypress test patient with "Depression screening performed for a reason" node; but, this node is negated. This results in the patient being placed in to both the denominator (depression screening performed) and the denominator exception (not performed for a reason). This is invalid in a few ways; first, the reason for performing the test would not be the same as the reason for not performing it. So, you can't simply negate the reason for performing and end up with a reason for not performing. Second, the way that this would be documented in any EHR, would be to present the user with an options for depression screening; the options would be "screening performed" and "screening not performed for medical reason" and "screening not performed for patient choice". You're going to check one of these boxes. You're not going to check "Screening Performed", and then click "Not performed because...". A good system wouldn't even allow this. So; if negation puts the patient in both denom and denom exception, this should be included in the definition of denom; i.e., patient had screening OR patient was excepted from screening... the intent is good, but, the definition/logic is bad... also having an external rule which says "any patient in the denom exception automatically goes in the denom" is bad too, because the eCQM should be complete without external definitions. I would guess this negation issue might apply to numerous other measures as well.