Thank you for inquiring about the Documentation of Current Medications in the Medical Record eCQM. Note that the Quality Data Model ( https://ecqi.healthit.gov/sites/default/files/QDM-v5.6-508.pdf ) states the following specific to negation rationale: "QDM 5.6 uses the syntax, “Procedure, not Performed” and this is then associated with either a DRC or a value set used to identify “the expected thing,” that in this case was not done. The negation rationale attribute value indicates a one-time documentation of a reason an activity is not performed”. The logic for the Denominator Exception criteria, shown below, uses the syntax “Procedure, Not Performed” and is then associated with the direct reference code (DRC) of SNOMEDCT (428191000124101) by the code description “Documentation of current medications (procedure)”. Therefore, to meet the denominator exception, providers will need to explicitly note, using structured documentation that aligns with your measure reporting vendor’s requirements, that the current medications documentation was not done. Then they would need to report a valid medical reason from the following value set: "Medical Reason" (2.16.840.1.113883.3.526.3.1007 found here: https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.526.3.1007/expansion/eCQM%20Update%202024-05-02 . (It is in the Terminology section of the screenshot that you provided with your inquiry.)   Denominator Exceptions logic from v14:   "Qualifying Encounter during day of Measurement Period" QualifyingEncounter   with ( ["Procedure, Not Performed": "Documentation of current medications (procedure)"]     union ["Intervention, Not Performed": "Documentation of current medications (procedure)"] ) MedicationsNotDocumented     such that MedicationsNotDocumented.authorDatetime during QualifyingEncounter.relevantPeriod       and MedicationsNotDocumented.negationRationale in "Medical Reason"   To clarify why the SNOMEDCT code (428191000124101) “Documentation of current medications (procedure)” is also used with the “Procedure, Performed” syntax is that to meet the Numerator criteria, shown below, the provider must need to explicitly note that the current medications documentation was performed.   Numerator logic from v14:   "Qualifying Encounter during day of Measurement Period" QualifyingEncounter   with ( ["Procedure, Performed": "Documentation of current medications (procedure)"]     union ["Intervention, Performed": "Documentation of current medications (procedure)"] ) MedicationsDocumented     such that Global."NormalizeInterval" ( MedicationsDocumented.relevantDatetime, MedicationsDocumented.relevantPeriod ) during day of QualifyingEncounter.relevantPeriod