![]() Address Advance Care Planning and any palliative care needs.Identify social supports including how much caregivers know and are willing to provide care.Conduct a safety evaluation for home and motor vehicle operation.Use standardized screening instruments to evaluate for neuropsychiatric and behavioral symptoms, including depression and anxiety.Reconcile and review for high-risk medications, if applicable.Use standardized instruments for staging of dementia like the Functional Assessment Staging Test (FAST) and Clinical Dementia Rating (CDR).Conduct a functional assessment of Basic and Instrumental Activities of Daily Living, including decision-making capacity.Record and review the patient’s history, reports, and records.Examine the patient with a focus on observing cognition.Typically, you would spend 60 minutes face-to-face with the patient and independent historian to perform the following elements during the cognitive assessment: An independent historian can be a parent, spouse, guardian, or other individual who provides patient history when a patient isn’t able to provide complete or reliable medical history. There must be an independent historian for assessments and corresponding care plans provided under CPT code 99483. The cognitive assessment includes a detailed history and patient exam. What’s Included in a Cognitive Assessment? You can perform the assessment at any of these locations: Where Can I Perform the Cognitive Assessment? Who Can Offer a Cognitive Assessment?Īny clinician eligible to report evaluation and management (E/M) services can offer this service. If you detect cognitive impairment at an AWV or other routine visit, you may perform a more detailed cognitive assessment and develop a care plan during a separate visit. This additional evaluation may be helpful to diagnose a person with dementia, such as Alzheimer’s disease, and to identify treatable causes or co-occurring conditions such as depression or anxiety. You may also use a brief cognitive test and evaluate health disparities, chronic conditions, and other factors that contribute to increased risk of cognitive impairment. You can also detect cognitive impairment as part of a routine visit through direct observation or by considering information from the patient, family, friends, caregivers, and others. How Do I Get Started?ĭetecting cognitive impairment is a required element of Medicare’s Annual Wellness Visit (AWV). If your patient shows signs of cognitive impairment during a routine visit, Medicare covers a separate visit to more thoroughly assess your patient’s cognitive function and develop a care plan – use CPT code 99483 to bill for this service.Īs of January 1, 2023, Medicare pays approximately $266 (may be geographically adjusted) for these services when provided in an office setting. The MoCA is a brief cognitive screening tool with high sensitivity and specificity for detecting MCI as currently conceptualized in patients performing in the normal range on the MMSE.If you're a person with Medicare, learn more about your Medicare coverage for Cognitive Assessment & Care Plan Services. MCI as an entity is evolving and somewhat controversial. Specificity was excellent for both MMSE and MoCA (100% and 87%, respectively). In the mild AD group, the MMSE had a sensitivity of 78%, whereas the MoCA detected 100%. Using a cutoff score 26, the MMSE had a sensitivity of 18% to detect MCI, whereas the MoCA detected 90% of MCI subjects. ![]() The MoCA and MMSE were administered to all participants, and sensitivity and specificity of both measures were assessed for detection of MCI and mild AD. Ninety-four patients meeting MCI clinical criteria supported by psychometric measures, 93 patients with mild Alzheimer's disease (AD) (Mini-Mental State Examination (MMSE) score > or =17), and 90 healthy elderly controls (NC). To develop a 10-minute cognitive screening tool (Montreal Cognitive Assessment, MoCA) to assist first-line physicians in detection of mild cognitive impairment (MCI), a clinical state that often progresses to dementia.Ī community clinic and an academic center.
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