Thank you for inquiring about CMS2v13, Preventive Care and Screening: Screening for Depression and Follow-Up Plan eCQM. In your scenario where the patient had two encounters and was screened positive without follow up during encounter two but was diagnosed with bipolar disorder during encounter one, the patient would be considered part of the denominator exclusion population (this was verified with MADIE logic testing). The eCQM is patient-based and does not require screening at all encounters. Since the patient was diagnosed as bipolar before any qualifying encounter, the patient would be considered in the denominator exclusion population.