A denominator exception is any condition that should remove a patient, procedure, or unit of measurement from the denominator of the performance rate only if the numerator criteria are not met. A denominator exception allows for adjustment of the calculated score for those providers with higher risk populations. A denominator exception also provides for the exercise of clinical judgment and should be specifically defined where capturing the information in a structured manner fits the clinical workflow. Denominator exception cases are removed from the denominator. However, the number of patients with valid exceptions may still be reported. Allowable reasons fall into three general categories - medical reasons, patient reasons, or system reasons. A denominator exception is used only in proportion measures.
Last Updated: Jan 14, 2021