2023 # MBHR11 Cognitive Assessment with Counseling on Safety and Potential Risk

Measure Title: Cognitive Assessment with Counseling on Safety and Potential Risk

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) reporting of results included counseling on safety and potential risks.

To see additional details, please view the workflow diagram for this measure: View diagram

Denominator: All patients regardless of age with a diagnosis that supports medical necessity for evaluation of cognitive functioning.

Denominator Criteria (Eligible cases):

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): 

96156; 96116; 96121; 96132; 96133; 96146; 96105; 96125; 96110

Numerator: 

Patients for whom a standardized valid assessment of cognition* was performed and reporting of results included counseling on safety and potential risks**.

*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 in Strauss, Sherman, & Spreen, A Compendium of Neuropsychological Tests [30].

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. Clinical judgment, commiserate with education and training, is needed in selecting and interpreting the chosen test(s).

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

**Safety Concerns and Potential Risk – include, but are not limited to, the following areas of concern and potential safety risks identified based on the results of cognitive assessment in one or more of the following areas:

• Fall risk/balance problems
• Medication management
• Financial management
• Home safety risks (e.g., cooking, smoking, etc.)
• Inability to respond rapidly to crisis/household emergencies
• Need for increased supervision due to memory problems, poor judgment, or decreased safety awareness
• Physical aggression posing threat to self, family caregiver, or others
• Possibility of getting lost/Wandering
• Community navigation/driving
• Access to firearms or other weapons
• Access to potentially dangerous materials
• Operation of hazardous equipment
• Vulnerability to undue influence of others who may have mal-intent
• Suicidality
• Abuse or neglect 
• Warning signs of disease progression and avoidance of risk for exacerbation of cognitive impairment
• Medical decision-making
• Comprehension of medical plan, treatment recommendations, and prognosis
• Presence of cognitive, psychosocial, or emotional barriers affecting adherence to medical recommendations

Denominator Exclusions: Death

Denominator Exceptions: 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

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