Skip to main content

Cognitive Assessment and Care Plan - Guidelines

Cognitive assessment and care plan services are provided when a comprehensive evaluation of a new or existing patient, who exhibits signs and/or symptoms of cognitive impairment, is required to establish or confirm a diagnosis, etiology, and severity for the condition.

Do not report cognitive assessment and care plan services if any of the required elements are not performed or are deemed unnecessary for the patient’s condition

A single physician or other qualified health care professional should not report 99483 more than once every 180 days.

CPT code 99483 provides reimbursement to physicians and other eligible billing practitioners for a comprehensive clinical visit that results in a written care plan

Eligible Provider

Any provider is eligible to report E/M services can provide this service. Eligible providers include physicians MD and DO, nurse practitioners, clinical nurse specialists, and physician assistants

Eligible practitioners must provide documentation that supports a moderate-to-high level of complexity in medical decision making, as defined by E/M guidelines.

The provider must also document the detailed care plan developed as a result of each required element covered by 99483

Required Elements to bill CPT 99483

CPT 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, with all of the following required elements,
  • Cognition-focused evaluation including a pertinent history and examination.
  • Medical decision-making of moderate or high complexity.
  • Functional assessment (eg, basic and instrumental activities of daily living), including decision-making capacity.
  • Use of standardized instruments for the staging of dementia (eg, functional assessment staging test [FAST], clinical dementia rating [CDR]).
  • Medication reconciliation and review for high-risk medications.
  • Evaluation for neuropsychiatric and behavioral symptoms, including depression, including use of standardized screening instrument(s).
  • Evaluation of safety (eg, home), including 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, neurocognitive symptoms, functional limitations, and referral to community resources as needed (eg, rehabilitation services, adult day programs, support groups) shared with the patient and/or caregiver with initial education and support.
  • Typically, 50 minutes are spent face-to-face with the patient and/or family or caregiver.
Many of the required assessment elements can be completed by appropriately trained members of the clinical team working with the eligible provider. 

Assessments that require the direct participation of a knowledgeable care partner or caregivers, such as a structured assessment of the patient’s functioning at home or a caregiver stress measure, may be completed prior to the clinical visit and provided to the clinician for inclusion in care planning. 

Care planning visits can be conducted in the office or other outpatient, home, domiciliary, or rest home settings.

Qualified health care professionals may report 99483 as frequently as once per 180 days

Tips

Do not report 99483 in conjunction with the following CPT codes,
  • E/M services - 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99366, 99367, 99368, 99497, 99498.
  • Psychiatric diagnostic procedures 90785, 90791, 90792.
  • Brief emotional/behavioral assessment - 96127.
  • Psychological or neuropsychological test administration 96146. 
  • Health risk assessment administration 96160, 96161.
  • Medication therapy management services 99605, 99606, 99607.

Popular posts from this blog

CPT Changes - New CPT Codes '2022

Glimpses of CPT Codes Updates - Effective from January 1st 2022 There are more than 400 codes are changes in 2022 from AMA. Total number codes are changed 405 and including of followings, New Codes -  249  Revised Codes - 93  Deleted Codes - 63 More than 40% of the editorial changes are tried to new technology services described in Category III CPT codes and the continued expansion of the proprietary laboratory analyses section of the CPT code set. Five new CPT codes are created for therapeutic remote monitoring codes 98975, 98976, 98977, 98980 and 98981 to increasingly important avenue of patient care especially during the COVID-19 pandemic. Five new CPT codes are created for complex care management codes 99424, 99425, 99426, 99427 and 99437 a nd there are some changes in chronic care management CPT codes as well. Six new CPT codes are created for Cardiac Catheterization codes 93593, 93594, 93595, 93596, 93597 and 93598 for congenital heart defects. Also, there are some changes in ele

Annual Preventive and Wellness Visit Service

Preventive Service Codes The annual preventive exam is a periodic, comprehensive preventive medicine evaluation (or reevaluation) and management of the patient. The CPT Code selection is based on whether the patient is receiving an initial visit -"New Patient" or a periodic - "Established Patient" preventive service, as well as the patient’s age. Initial Visits - 99381, 99382, 99383, 99384, 99385, 99386, 99387 Subsequent Visits - 99391, 99392, 99393, 99394, 99395, 99396, 99397 The Medicare insurance would be covered by "G" codes instead of the above codes. The details below, Welcome to Medicare - G0402 (Within the one year from the patient enrolled in Medicare) Initial Annual Wellness Visit - G0438 (After the 1st year of enrollment) Subsequent Annual Wellness Visit - G0439 Initial Visits Initial comprehensive preventive medicine evaluation and management of an individual including an" age and gender appropriate history, examination, counseling/anticip

CPT Changes - Deleted CPT Codes'2022

 CPT Code CPT Description 0191T Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach, into the trabecular meshwork; initial insertion 01935 Anesthesia for percutaneous image guided procedures on the spine and spinal cord; diagnostic 01936 Anesthesia for percutaneous image guided procedures on the spine and spinal cord; therapeutic 0208U Oncology (medullary thyroid carcinoma), mRNA, gene expression analysis of 108 genes, utilizing fine needle aspirate, algorithm reported as positive or negative for medullary thyroid carcinoma 0290T Corneal incisions in the recipient cornea created using a laser, in preparation for penetrating or lamellar keratoplasty (List separately in addition to code for primary procedure) 0355T Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), colon, with interpretation and report 0356T Insertion of drug-eluting implant (including punctal dilation and implant removal when performe