Up-to-Code: Changes to dementia care planning codes
On Jan. 1, 2018, the Centers for Medicare and Medicaid Services (CMS) replaced Healthcare Common Procedure Coding System code G0505 with Current Procedural Terminology® code 99483 — assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home — to evaluate a patient with cognitive impairment and pay separately for the assessment and care plan creation for beneficiaries with cognitive impairment, such as Alzheimer’s disease or dementia, at any stage of impairment.
All of the following elements must be met in order to report the new code (99483):
- Cognition-focused evaluation including a pertinent history and examination.
- Medical decision making of moderate or high complexity.
- Functional assessment, including decision-making capacity.
- Use of standardized instruments for staging of dementia.
- Evaluation for neuropsychiatric and behavioral symptoms, including depression and use of standardized screening instrument(s).
- Evaluation of safety (e.g., home, motor vehicle operation).
- Identification of caregiver(s), caregiver knowledge, caregiver needs, social supports, and the willingness of caregiver to take on caregiving tasks.
- Development, updating or revision, or review of an Advance Care Plan.
- Creation of a written care plan — including initial plans to address any neuropsychiatric symptoms, neuro-cognitive symptoms, functional limitations and referral to community resources as needed (e.g., rehabilitation services, adult day programs, support groups) — that is shared with the patient and/or caregiver with initial education and support.
While the work of clinical psychologists is critical in the cognitive assessment and care of older adults, and psychologists have long been members of dementia care teams, they are unfortunately unable to use this new code because it is classified as an evaluation and management (E/M) code. CMS only recognizes physicians and physician extenders, such as nurse practitioners, as being able to provide E/M services. However, psychologists can and should continue to use psychological testing codes (96101-96102) and neuropsychological testing codes (96118-96119) to provide services as part of the dementia care team.