Jurisdictions J, M and RRB SMAC Part B Medicare Cognitive Assessment and Care Plan Services Webinar: Questions and Answers

Published 06/24/2021

The following questions were received and answered during our May 25, 2021, webinar.

Question 1: How does the cognitive assessment 99483 differ from the "assess cognitive function" required within the IPPE/AWV when it comes to supporting documentation for each?

Answer: If your patient shows signs of cognitive impairment during a routine visit, Medicare covers a separate visit to assess your patient’s cognitive function more thoroughly and to develop a care plan. Please use CPT code 99483 to bill for this service.

Addendum: The CMS MLN Medicare Wellness Visits Educational Tool provides guidelines for IPPE visits and initial and subsequent annual wellness visit (AWV). “Detect any cognitive impairment patients may have” is a component of both initial and subsequent AWV. For this component, CMS provides the following guidelines:

Assess cognitive function by direct observation, considering information from the patient, family, friends, caregivers, and others. Consider using a brief cognitive test, health disparities, chronic conditions, and other factors that contribute to increased cognitive impairment risk. Find more information on the National Institute on Aging’s Alzheimer’s and Dementia Resources for Professionals website. 

The “What’s Included in a Cognitive Assessment?” section of the CMS Cognitive Assessment & Care Plan Services web page provides the following guidelines for CPT code 99483: 

The cognitive assessment includes a detailed history and patient exam. There must be an independent historian for assessments and corresponding care plans provided under CPT code 99483. 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. 

Typically, you would spend 50 minutes face-to-face with the patient and independent historian to perform the following elements during the cognitive assessment: 

  • Examine the patient with a focus on observing cognition 
  • Record and review the patient’s history, reports, and records 
  • Conduct a functional assessment of Basic and Instrumental Activities of Daily Living, including decision-making capacity
  • Use standardized instruments for staging of dementia like the Functional Assessment Staging Test (FAST) and Clinical Dementia Rating (CDR)
  • Reconcile and review for high-risk medications, if applicable 
  • Use standardized screening instruments to evaluate for neuropsychiatric and behavioral symptoms, including depression and anxiety
  • Conduct a safety evaluation for home and motor vehicle operation 
  • Identify social supports including how much caregivers know and are willing to provide care
  • Address Advance Care Planning and any palliative care needs 
     

Question 2: Where do I get a copy of the PowerPoint slides for this presentation?

Answer: A PDF of today's webcast will be provided to you via the resources list within the ON24 platform. A copy of today’s presentation will also be sent out the email address that you provided when you registered for this event. Also, you may view the video that was shared during today’s webcast by utilizing the link provided in the following resource.

Resource: CMS Medicare Coverage and Payment of Cognitive Assessment and Care Plan Services Medicare Learning Network Video.
 

Question 3: For the time frame where there is no sound during your presentation, did I miss anything?

Answer: When there was no sound during the presentation, attendees should have clicked the play button to view the video that was included in this presentation. You may still view this video by utilizing the link provided in the following resource. 

Resource: CMS Medicare Coverage and Payment of Cognitive Assessment and Care Plan Services Medicare Learning Network Video.
 

Question 4: Is this going to be replayed? I was unable to get in and now that I am finally in, it is over.

Answer: Yes. An on-demand recording of this presentation will be available to you after this webcast. You may access the presentation by using the link on your registration email. The recording for today’s event will also be posted on our website within two weeks following today’s webcast. To start the video that’s included in today’s webcast, please click the play button. If this is not successful, you may view this video by utilizing the link provided in the following resource.

Resource: CMS Medicare Coverage and Payment of Cognitive Assessment and Care Plan Services Medicare Learning Network Video.
 

Question 5: What is the event code for this session? 

Answer: The course code for this event, which you can add to your Certificate of Attendance is JRB 3169240. 


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