Thank you for your inquiry about the Preventive Care and Screening: Screening for Depression and Follow-Up Plan (CMS2v9). For implementation in 2020, the denominator exclusion is only met if the patient had a diagnosis of depression or bipolar disorder which both started before the start of the denominator eligible encounter AND that the diagnosis was still active at the time of the start of the encounter. This aligns with the denominator exclusion language, as published in CMS2v9: "Patients with an active diagnosis for depression or a diagnosis of bipolar disorder." Therefore, if the patient had never had a diagnosis of bipolar disorder (or depression) prior to this encounter, the patient would be included in the initial population of this measure, as long as all other criteria are met (patient is 12 years or older at the start of the measurement period and there exists a "Qualifying Encounter for Depression Screening"). However, it is important to note that during this past annual update cycle, this measure underwent changes that are included in the 2021 version of the measure, specific to how the denominator exclusion is applied. Namely, in CMS2v10, the denominator exclusion language has been revised to: "Patients who have been diagnosed with depression or with bipolar disorder." This change resulted from discussions with the measure steward, developer, and clinical experts, as well as the addition of measure guidance published in v10 that notes the intent of the measure is to screen for depression in patients who have never had a diagnosis of depression or bipolar disorder prior to the eligible encounter used to evaluate the numerator. Patients who have ever been diagnosed with depression or bipolar disorder will be excluded from the measure beginning with the 2021 implementation.

Exclusion HR condition is- Denominator Exclusions = OR: "Diagnosis: Depression diagnosis" satisfies all: starts before start of ("Encounter, Performed: Depression Screening Encounter Codes" during "Measurement Period" ) overlaps ("Encounter, Performed: Depression Screening Encounter Codes" during "Measurement Period" ) OR: "Diagnosis: Bipolar Diagnosis" satisfies all: starts before start of ("Encounter, Performed: Depression Screening Encounter Codes" during "Measurement Period" ) overlaps ("Encounter, Performed: Depression Screening Encounter Codes" during "Measurement Period" ) element practiceid element_date element_stop_date depression screening encounter 2701 3/5/2020 8:00 2020-03-05 08:30:00+0000 bipolar disorder 2701 3/5/2020 8:30 2020-12-11 08:30:00+0000 The Depression Screening Encounter Codes is before the bipolar diagnosis. So this patient should not go in exclusion. Per logic, exists ( ["Diagnosis": "Bipolar Diagnosis"] DiagnosisBipolar with "Qualifying Encounter for Depression Screening" QualifyingEncounter such that DiagnosisBipolar.prevalencePeriod overlaps before QualifyingEncounter.relevantPeriod. over here diagnosis does not overlap before the encounter. Kindly confirm Regards, Amit