The cognitive care plan as a mini-case conference

We’ve been outlining the rationale and requirements of the cognitive care plan (CCP), formally recognized as a billable service under Current Procedural Terminology (CPT®) code 99483 in 2018. In this post, we’ll delve further into the value of comprehensive care planning.

The reason so many physicians aren't providing cognitive care plans

The design of 99483 requires the physician to gather and synthesize inputs from the patient’s medical history, evaluation/reevaluation of current cognitive and medical health, formal cognitive and behavioral testing, and a variety of family/caregiver inputs. When the health challenges of aging are compounded by cognitive impairment, problem-focused visits with the physician may no longer fully address the complexity of care.

Frailty, fall risk, polypharmacy, social isolation, behavioral health, and caregiver stress are among the risk factors facing the cognitively impaired individual. Addressing these myriad factors as well as the chief complaint in a 15-minute visit is essentially impossible.

A physician-directed mini-case conference

Let’s then think of the CCP as a physician-directed mini-case conference. The lobbying efforts of the Alzheimer’s Association and others prompted the Centers for Medicare & Medicaid Services (CMS) to codify 99483 as a combined case review and patient/family plan for the course of illness.

The generous RVU ($263.81 before geographic adjustment) takes into account the substantial activity on the part of the physician in pulling together the full range of health data and subsequent medical decision-making to direct the CCP — over and above time spent with patient and family.

Assess cognition, collect patient and family inputs, deliver a comprehensive plan

BrainCheck Care™ aims to assist the physician in developing the CCP by providing assessments of cognition as well as depression and anxiety. BrainCheck’s iPad-based platform then gives the family the opportunity to rate functional impairment, activities of daily living (ADLs), home safety, and caregiver stress. These are the formal inputs required to satisfy CPT 99483 requirements but are challenging for the physician to collect in a patient visit.

BrainCheck Care then assists with the delivery of the formal family plan by individualizing information based on assessment findings and providing a written plan for the family to assist in the management of cognitive impairment.

We can provide interested clinicians with additional information about code requirements as well as information about how BrainCheck Care helps the physician in delivering this needed service.