We have been reviewing our depression screening data for several weeks and noticed issues with our performance. Upon review, we identified an issue with the denominator exception. Our EHR does not account for denominator exception (patient reason or medical reason) if the patient has a subsequent visit. For example, if we documented that the patient refused screening on June 1, 2024, the EHR would remove the patient from the denominator. However, if the patient had a follow-up visit on June 20, the EHR vendor is arguing that the provider should be required to ask again and document if the patient refuses again. If an exception is not documented again, it lists the the patient as Unmet. Since the measure is patient specific and to respect the wishes of our patients, we do not attempt a screen at subsequent visits. We are seeking confirmation if the denominator exception entry is required for every single encounter a patient has in the performance period.