2023 # MBHR16 Comprehensive Cognitive Assessment Assists with Differential Diagnosis

Measure Title: Comprehensive Cognitive Assessment Assists with Differential Diagnosis

Description: Percentage of patients, regardless of age, referred for evaluation due to concerns for cognitive impairment for whom 1) a standardized valid assessment of cognition was performed and 2) results of assessment informed determination of diagnosis or further clarified etiological factors of cognitive impairment or complaints.

Denominator: 

All patients, regardless of age, where there is documentation of concerns regarding cognitive changes or difficulties. Reported concerns may come from: the patient, a treating provider, or a caregiver of the patient.

AND

Patient encounter during the performance period (CPT): 

96116; 96121; 96132; 96133; 96105; 96125; 96110; 90791

Numerator: 

Patients for whom a standardized valid assessment of cognition* was performed and assessment results assisted with clarification of differential diagnosis or etiological factors of cognitive impairment or complaints.

*See definitions below for details

*Note that reporting of results can be satisfied through a detailed written report/feedback note/chart note within medical documentation or providing feedback with the receiver. No resulting diagnosis is required for this measure. That is, testing results may indicate that cognitive abilities are within normal limits and there is no objective evidence for diagnosis of cognitive impairment or specific cognitive disorder. When cognitive complaints are present and objective cognitive assessment does not indicate the presence of a cognitive or other associated medical disorder, testing results may provide clarification of potential causal factors contributing to subjective complaints.

Definitions:  

Standardized cognitive assessment – refers to the administration of reliable and research-validated assessment methods or tests that cover one or a combination of the following cognitive domains: memory, language, visual-spatial, executive functioning, academic skills, developmental level, intellectual functioning, attention, and processing speed. Depending on medical needs, referral question, and patient characteristics, cognitive assessment may entail targeted assessment of a particular cognitive domain or a comprehensive assessment battery encompassing multiple domains. Assessment of functional abilities and activities of daily living may also be included in these evaluations. Psychological functioning may also be formally assessed to identify whether emotional or social factors are influencing cognitive functioning. Meeting performance for this measure is not limited to a specific cognitive test as long as it meets the above criteria and is commonly accepted within the medical community. Examples of well validated and commonly accepted cognitive tests can be found in Strauss, Sherman, & Spreen, A Compendium of Neuropsychological Tests [16].

The following list is illustrative of types of tests and test batteries that would meet this criterion and are not meant to be equal or interchangeable. Note that although screening measures (e.g., Montreal Cognitive assessment (MoCA); Mini-Mental Status Examination (MMSE)) are adequate and appropriate to determine the presence of cognitive impairment, they should not be used in isolation to make diagnostic determinations [24,25]. Clinical judgment, commiserate with education and training, is needed in selecting and interpreting the chosen test(s).

• Neuropsychological Assessment Battery (NAB)
• Boston Diagnostic Aphasia Examination (BDAE)
• California Verbal Learning Test-Third Edition (CVLT3)
• Wechsler Memory Scale-Fourth Edition (WMS-IV)
• Katz Index of Independence in Activities of Daily Living
• Lawton Instrumental Activities of Daily Living Scale (IADL) 

Receiver: The individual that is provided test results and subsequent healthcare actions. This may include the patient OR a caregiver OR the referring provider OR a treatment team member OR a treating physician.

Denominator Exclusions: Death

Denominator Exceptions: Clarification of differential diagnosis or etiological factors of cognitive impairment or complaints is not documented in the report with explanation

OR

Patients present with an acute condition or crisis who are not administered a standardized cognitive assessment

OR

Patient refuses to participate or is unable to complete the assessment

National Quality Forum (NQF) number, if applicable
N/A

Care setting(s) 
Ambulatory Care: Clinician Office/Clinic; Ambulatory Care: Hospital; Home Care; Hospital; Hospital Inpatient; Hospital Outpatient; Long Term Care; Nursing Home; Outpatient Services; Rehabilitation Facility; Rehabilitation Facility: Inpatient

Telehealth, if applicable
Yes

Number of performance rates required for measures
1

Traditional vs. inverse measure
Traditional

Proportional, continuous variable, and/or ratio measure indicator
Proportional

Risk adjustment, if applicable
No

Submission pathway 
Traditional MIPS