Thank you for inquiring about the Preventive Care and Screening: Screening for Depression and Follow-Up Plan eCQM. Once a bipolar disorder diagnosis is present in the record (the type of encounter that documents it does not matter) and there are any subsequent encounters (with or without screening), the measure considers the patient excluded from measure consideration (clinically, patients with a bipolar diagnosis should be seeing a psychiatric care provider specific to these needs, and this provider would also be able to address depression). Please note that in eCQMs, denominator exclusions remove patients from the qualifying population before determining if they meet the numerator criteria.   Example: 1. Look at all qualifying encounters during measurement period Per scenario: 4/3/25; 5/11/25 2. Determine if there was a bipolar diagnosis prior to any of the qualifying encounters Per scenario: Yes, on 5/3/25 (qualifying encounter 5/11/25) 3. If yes, exclude (and STOP evaluation) Per scenario: Patient meets denominator exclusion. 4. If no, check to see if they were screened for depression 5. If screened positive for depression, was there follow-up… etc.   In your presented scenario, the patient would have met the denominator exclusion because there was a qualifying encounter after the bipolar disorder diagnosis. You do not use the most recent qualifying encounter; it is a matter of determining if there was a bipolar diagnosis prior to any qualifying encounter.