Alzheimer Disease and Dementias: Early Detection and Care Planning _ ______________________________
TESTS/EXAMINATIONS TYPICALLY USED TO DIAGNOSE ALZHEIMER DISEASE
Test/Examination
Assessment
Montreal Cognitive Assessment (MoCA)
Evaluates short-term memory, visuospatial abilities, attention/ concentration/memory, executive function, language, and orientation to time and place Short test that assesses executive function, information registration, recall, language, ability to follow simple commands, and orientation to time and place
Mini-Mental State Examination (MMSE)
Bloodwork
Complete blood count (CBC) Liver function Glucose Thyroid function HIV Electrolytes Folate test Vitamin B12 concentration
CT scan
Evaluate the severity of brain degeneration
Magnetic resonance imaging (MRI)
Deep insight into brain looking for tumors, nerve damage, and unusual markings
Electroencephalogram (EEG)
Measure and evaluate brain wave activity Identify Alzheimer disease amyloid proteins
Positron emission tomography (PET)
Source: [2]
Table 4
and orientation, with scores less than 26 indicating impair- ment. The CDT evaluates executive function and visuospatial abilities by having patients draw a clock showing a specific time [15; 16; 17; 18]. Administering these tools requires a standardized approach for accuracy. The MMSE and MoCA involve guided tasks and scoring, while the CDT involves drawing a clock. Scores are compared with normative data, considering age, education, and cultural background [15; 16; 17; 18]. Choosing the right tool depends on the patient’s clinical presentation and the cognitive domains needing assessment. Other factors to consider include the patient’s language proficiency, cultural background, and any sensory or motor impairments that may affect their performance on the tests. Healthcare providers should also consider the psychometric properties of the tools, such as their sensitivity, specificity, and reliability, to ensure accurate and meaningful results. The MMSE is good for quick screenings, the MoCA for com- prehensive evaluations, and the CDT for executive function and visuospatial skills. Multiple tools can enhance diagnostic accuracy, with the MoCA being particularly sensitive for early impairment detection [15; 18]. COGNITIVE ASSESSMENT BILLING Billing for cognitive assessment and care planning is essential for ensuring that healthcare providers are reimbursed for the time and resources spent on these critical services. The Centers
for Medicare & Medicaid Services (CMS) have established specific billing codes for cognitive assessment and care plan- ning services. These codes allow healthcare providers to bill for the time spent on comprehensive cognitive assessments and care planning for patients with cognitive impairment, including Alzheimer disease and other dementias [4]. The primary codes include [19]: • CPT code 99483: Used for a comprehensive cognitive assessment and care planning for patients with cogni- tive impairment, including Alzheimer disease and other dementias. It covers services such as evaluating cogni- tion, functional status, medication review, and the development of a care plan. Clinicians allowed to bill under this code include physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certi- fied nurse midwives. This code can be used once per 180 days (about every 6 months). • CPT code 99484: Used for standardized cognitive performance testing, which includes the administration and scoring of tests to assess cognitive function The code HCPCS code G0505 was previously used for cogni- tive and functional assessment and care planning for patients with cognitive impairment, including Alzheimer disease and other dementias. It has been replaced by CPT Code 99483 [20]. Table 5 lists other diagnostic codes commonly used in the care of cognitive impairment or dementia.
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MDRI2026
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