Thank you for your inquiry regarding CMS149: Dementia: Cognitive Assessment. Denominator exclusions are intended to take specific groups (e.g., certain diagnoses or situations) out of the measure before the denominator is identified. This measure does not have any exclusions. Denominator exceptions are taken into account after the numerator has been calculated. If a patient did not meet the numerator component, then the algorithm will check to see if the patient meets any of the exceptions. Exceptions include things we often refer to as the 'art of medicine' like patients refusing an assessment or medication or patients who are unable to participate in an assessment. The exception for this measure is "Documentation of patient reason(s) for not assessing cognition." The codes associated with the phrase include patient noncompliance and patient refusal. I have included a table below with the approved exceptions. Code Code description Code system 105480006 Procedure declined by patient (situation) SNOMEDCT 160932005 Financial problem (finding) SNOMEDCT 160934006 Financial circumstances change (finding) SNOMEDCT 182890002 Patient requests alternative treatment (finding) SNOMEDCT 182895007 Drug declined by patient (situation) SNOMEDCT 182897004 Drug declined by patient - side effects (situation) SNOMEDCT 182900006 Drug declined by patient - patient beliefs (situation) SNOMEDCT 182902003 Drug declined by patient - cannot pay script (situation) SNOMEDCT 183945002 Procedure declined for religious reason (situation) SNOMEDCT 184081006 Patient has moved away (finding) SNOMEDCT 185479006 Patient dissatisfied with result (finding) SNOMEDCT 185481008 Dissatisfied with doctor (finding) SNOMEDCT 224187001 Variable income (finding) SNOMEDCT 225928004 Patient self-discharge against medical advice (procedure) SNOMEDCT 266710000 Drugs not taken/completed (situation) SNOMEDCT 266966009 Family illness (situation) SNOMEDCT 275694009 Patient defaulted from follow-up (finding) SNOMEDCT 275936005 Patient noncompliance - general (situation) SNOMEDCT 281399006 Did not attend (finding) SNOMEDCT 310343007 Further opinion sought (finding) SNOMEDCT 373787003 Treatment delay - patient choice (finding) SNOMEDCT 406149000 Medication declined (situation) SNOMEDCT 408367005 Patient forgets to take medication (finding) SNOMEDCT 413311005 Patient non-compliant - declined intervention / support (situation) SNOMEDCT 416432009 Procedure not wanted (situation) SNOMEDCT 423656007 Income insufficient to buy necessities (finding) SNOMEDCT 424739004 Income sufficient to buy only necessities (finding) SNOMEDCT 443390004 Refused (qualifier value) SNOMEDCT 713247000 Procedure discontinued by patient (situation) SNOMEDCT   The assessment tools for this measure include: Brief Interview for Mental Status (BIMS) St. Louis University Mental Status Examination (SLUMS) Ascertain Dementia 8 (AD8) Mini-Mental State Examination (MMSE) Montreal Cognitive Assessment (MoCA) Blessed Orientation-Memory-Concentration Test (BOMC) Mini-Cog Code Code description Code system 58151-2 Prior assessment Brief Interview for Mental Status (BIMS) summary score [MDSv3] LOINC 71492-3 Total score [SLUMS] LOINC 71493-1 Total score [IQCODE] LOINC 71722-3 Total score [AD8] LOINC 72106-8 Total score [MMSE] LOINC 72172-0 Total score [MoCA] LOINC 72173-8 Total score [BOMC] LOINC 72233-0 Total score [Mini-Cog] LOINC