Thank you for your inquiry on CMS2v13: Preventive Care and Screening: Screening for Depression and Follow-Up Plan. In your question it seems you are referring to the Denominator Exception not Denominator Exclusion (i.e., patient diagnosed with bipolar disease). In your example, if the patient has a screening in March (and met the Numerator), then returns for a visit in April and a documented patient reason for not screening is captured, the patient will still meet the Numerator (i.e., March encounter). The measure is patient-based and if the Numerator was met, it would report the Numerator for the patient. For additional information on measure scoring, please refer to Section 1.3 of Electronic Clinical Quality Measure Logic and Implementation Guidance v7 on the eCQI Resource Center ( https://ecqi.healthit.gov/sites/default/files/eCQM-Logic-and-Guidance-v7.pdf ).