Yet another reason to implement Annual Wellness Visits into your CDI/coding efforts

Detection of early cognitive decline the latest benefit of covered Medicare/Medicare Advantage service

By Brian Murphy

Medicare Annual Wellness Visits (AWVs) are an important piece of patient wellness and appropriate capture of acuity/severity of illness.

But they’re also underutilized.

You can now add another reason why you should be working to use them as a tool in your CDI and coding efforts.

A recent study by the Journal of the American Medical Association (JAMA) revealed that AWVs are a powerful tool in diagnosis of early cognitive decline.

Per MedPage Today, which reviewed the JAMA study, key takeaways include:

Medicare AWVs were associated with a 21% increase in mild cognitive impairment diagnoses.
Those with a wellness evaluation received a diagnosis 76 days earlier than others.
Findings suggest the Medicare wellness visit policy may help identify cognitive impairment earlier.

All this data was derived from Medicare billing data. Your queries and carefully selected codes help track disease incidence and influence patient care.

There are some surprises here, from my perspective.

One is that AWVs are still so little used. The study was of approximately 550,000 Medicare beneficiaries in Texas with no diagnosis of mild cognitive impairment or dementia from 2015 to 2017.

Only 12.1% had an AWV.

AWVs are fully covered by Medicare and Medicare Advantage and result in no substantial financial burden on patients. In short, there’s no reason not to use them. I’ve written on this subject before and am including a link below to an article on the Norwood website.

The second surprise for me was how little specificity seems to matter to CMS, at least from a reimbursement perspective. They want specificity, but don’t always pay for it.

Researchers in the study noted that early recognition of cognitive impairment is key to optimal dementia care. Which started me down a bit of a dementia rabbit hole.

It’s crazy to me that the various types of dementias (F0 series in ICD-10-CM) are all weighted equally as CCs, regardless of severity level. For example, all these conditions are considered CCs by CMS:

F03.A4, Unspecified dementia, mild, with anxiety
F01.B3, Vascular dementia, moderate, with mood disturbance
F03.C2: Unspecified dementia, severe, with psychotic disturbance

None are MCCs.

Wild, considering how devastating severe demenia is. Dementia patients are often unable to get dressed or eat without help. They lose their ability to solve problems or control their emotions. Their personalities may change, including agitation and hallucination.

What does matter is behavioral manifestations. Dementia without these (for example, F03.A0, unspecified dementia, mild, without behavioral disturbance) does not qualify as a CC.

Specificity also matters in Medicare Advantage, but not as you might expect. V24 of CMS-HCCs breaks out dementia into just two buckets; with complications (HCC 51) and without (HCC 52). V28 further classifies by severe (125), moderate (126), and mild or unspecified 127—but strangely all have the same RAF score (0.341).

Resources
MedPage Today

Norwood, “Annual Wellness Visits: Heart of a value-based CDI program”