Measure Description
Percentage of all patients with a diagnosis of Parkinson’s disease (PD) who were assessed for cognitive impairment or dysfunction once during the measurement period.
Instructions
This measure is to be submitted a minimum of once per performance period for patients with a diagnosis of Parkinson’s disease seen during the performance period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.
Intent and Clinician Applicability:
This measure is intended to reflect the quality of services provided for patients with a diagnosis of Parkinson’s disease (PD). This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding. Measure Strata and Performance Rates: This measure contains one strata defined by a single submission criteria. This measure produces a single performance rate. Implementation Considerations: For the purposes of MIPS implementation, this patient-process measure is submitted a minimum of once per patient during the performance period. The most advantageous quality data code will be used if the measure is submitted more than once.
Telehealth:
TELEHEALTH ELIGIBLE: This measure is appropriate for and applicable to the telehealth setting. Patient encounters conducted via telehealth using encounter code(s) found in the denominator encounter criteria are allowed for this measure. Therefore, if the patient meets all denominator criteria for a telehealth encounter, it would be appropriate to include them in the denominator eligible patient population. Telehealth eligibility is at the measure level for inclusion within the denominator eligible patient population and based on the measure specification definitions which are independent of changes to coding and/or billing practices.
Measure Submission:
The quality data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this collection type for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. The coding provided to identify the measure criteria: Denominator or Numerator, may be an example of coding that could be used to identify patients that meet the intent of this clinical topic. When implementing this measure, please refer to the ‘Reference Coding’ section to determine if other codes or code languages that meet the intent of the criteria may also be used within the medical record to identify and/or assess patients. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.
Denominator
All patients with a diagnosis of Parkinson’s disease
DENOMINATOR NOTE: *Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs.
Denominator Criteria (Eligible Cases):
All patients regardless of age
AND
Diagnosis for Parkinson’s disease (ICD-10-CM): G20.A1, G20.A2, G20.B1, G20.B2, G20.C
AND
Patient encounter during the performance period (CPT): 90791, 90792, 90839, 96105, 96110*, 96112, 96116, 96125, 96130, 96132, 96156, 97129, 97165, 97166, 97167, 97168, 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99421, 99422, 99423, 99483
Numerator
Patients (or care partner as appropriate) who were assessed for cognitive impairment or dysfunction once during the measurement period
Definition:
Assessed – Is defined as a discussion with the patient or care partner or use of a screening tool OR referral to neuropsychologist for testing.
Numerator Instructions:
Screening tools approved for use in this measure include:
- Dementia Rating Scale (DRS-2)
- Mini-Mental Status Examination (MMSE)
- Montreal Cognitive Assessment (MoCA)
- Neuro-QoL
- Parkinson’s Disease Dementia – Short Screen (PDD-SS)
- Parkinson Neuropsychiatric Dementia Assessment (PANDA)
- Parkinson’s Disease- Cognitive Rating Scale (PD-CRS)
- Patient-Reported Outcomes Measurement Information System (PROMIS)
- Scales for Outcomes of Parkinson’s Disease – Cognition (SCOPA- Cog)
Numerator Options:
Performance Met: Cognitive impairment or dysfunction assessed (3720F)
OR
Denominator Exception: Patient or care partner decline assessment (G0036)
OR
Denominator Exception: On date of encounter, patient is not able to participate in assessment or screening, including non-verbal patients, delirious, severely aphasic, severely developmentally delayed, severe visual or hearing impairment and for those patients, no knowledgeable informant available. (G0037)
OR
Performance Not Met: Cognitive impairment or dysfunction was not assessed, reason not otherwise specified (3720F with 8P)
Rationale
Cognitive functioning impacts life satisfaction and health-related quality of life. It is anticipated that if assessed on an ongoing basis, cognitive deficits may be identified and addressed in a timely manner. Once identified, such deficits could be treated (or patients referred to appropriate resources) and thereby improve individuals quality of life.
Clinical Recommendation Statements
- The Mini-Mental State Examination (MMSE) and the Cambridge Cognitive Examination (CAM Cog) should be considered as screening tools for dementia in patients with PD (Level B).(4)
- An assessment of neuropsychological functioning in a person presenting with parkinsonism suspected of being PD is recommended (Level A) and should include: (I) A collateral history from a reliable carer (II) A brief assessment of cognition (III) Screening for a rapid eye movement (REM) sleep behavior disorder (RBD), psychotic manifestations and severe depression.(5)
- Clinical history should be supplemented by an informant (GPP). A neurological and general physical examination should be performed in all patients with dementia (GPP).(6)
- Cognitive assessment is central to diagnosis and management of dementias and should be performed in all patients (Level A). Screening tests are available of good accuracy in the general diagnosis of dementia or have been proposed specifically for the differential diagnosis between the different forms of dementia (GPP). Neuropsychological assessment should be performed in all patients in the early stages of the disease (Level B) when the cognitive impairment reflects the disruption of specific brain structures. The neuropsychological assessment should include a global cognitive measure and, in addition, more detailed testing of the main cognitive domains including memory, executive functions and instrumental functions (Level C).(6)
- The general practitioner knows the cognitive-behavioral profile of his/her patients and can identify the clinical signs of cognitive decay at their onset, taking also into account the observation of relatives (I/A).(7)
- General practitioners should assess all pathological conditions that could cause cognitive disorders (VI/A).(7)
- In raising the diagnostic hypothesis of dementia, general practitioners should assess the presence of comorbidities and identify risk factors due to social isolation (VI/A).(7)