I am inquiring on whether or not patient refusal is allowed for depression follow up plan for CMS 2. For instance, a patient has a positive depression screening and the provider suggests treatment whether a referral for mental health or a medication and the patient refuses the treatment.  Is the refusal of treatment an exclusion for this measure or is the patient refusal exception only applicable if the patient is refusing the screening itself? 

I believe there are established SNOMED codes that could be used in these instances if the refusal of treatment is found to be an appropriate exclusion. 

For treatment refusal to be included in Denominator Exceptions

Current Exceptions:
Patient Reason(s)
Patient refuses to participate OR
Medical Reason(s)

Documentation of medical reason for not screening patient for depression (e.g., cognitive, functional, or motivational limitations that may impact accuracy of results; patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient's health status)