download chevron-down chevron-right chevron-with-circle-down chevron-with-circle-up check circle-with-minus circle-with-plus export help-with-circle inbox link mail old-phone star-outlined star user v-card close close close Back to top
Top
Top of Content

CMS149v7 - Dementia: Cognitive Assessment

Rationale:

Dementia: Cognitive Assessment. Dementia is often characterized by the gradual onset and continuing cognitive decline in one or more domains including memory, executive function, language, judgment, and spatial abilities. (APA, 2007) Cognitive deterioration represents a major source of morbidity and mortality and poses a significant burden on affected individuals and their caregivers. (NIH, 2010) Although cognitive deterioration follows a different course depending on the type of dementia, significant rates of decline have been reported. For example, one study found that the annual rate of decline for Alzheimer's disease patients was more than four times that of older adults with no cognitive impairment. (Wilson et al., 2010) Nevertheless, measurable cognitive abilities remain throughout the course of dementia. (APA, 2007) Initial and ongoing assessments of cognition are fundamental to the proper management of patients with dementia. These assessments serve as the basis for identifying treatment goals, developing a treatment plan, monitoring the effects of treatment, and modifying treatment as appropriate.

    • Data Elements

      Value Set Description from VSAC:
      This value set contains concepts related to the total score results for the standardized tools used for the assessment of cognition.
      This value set may use QDM category Assessment
      Includes total score results for the following standardized tools: -Blessed Orientation-Memory-Concentration Test (BOMC) -Montreal Cognitive Assessment (MoCA) -St. Louis University Mental Status Examination (SLUMS) -Mini-Mental State Examination (MMSE) [Note: The MMSE has not been well validated for non-Alzheimer's dementias] -Short Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) -Ascertain Dementia 8 (AD8) Questionnaire -Minimum Data Set (MDS) Brief Interview of Mental Status (BIMS) [Note: Validated for use with nursing home patients only] -Formal neuropsychological evaluation -Mini-Cog
      No exclusions.

      Constrained to codes in the Standardized Tools For Of Cognition value set (2.16.840.1.113883.3.526.3.1006)

      QDM Datatype - Assessment Performed: Data elements that meet criteria using this datatype should document completion of the assessment indicated by the QDM category and its corresponding value set. Timing: The time the assessment is completed; Author dateTime.
      Value Set Description from VSAC:
      This value set contains concepts related to dementia diagnoses and mental degenerations diagnoses.
      This value set may use QDM category Diagnosis.
      Includes all relevant concepts related to dementia diagnoses and mental degeneration diagnoses.
      Does not include dementia and mental degeneration diagnoses in remission.

      Constrained to codes in the Dementia Mental Degenerations value set (2.16.840.1.113883.3.526.3.1005)

      QDM Datatype - Diagnosis: Data elements that meet criteria using this datatype should document the Condition/Diagnosis/Problem and its corresponding value set. The onset dateTime corresponds to the implicit start dateTime of the datatype and the abatement dateTime corresponds to the implicit stop dateTime of the datatype. If the abatement dateTime is not present, then the diagnosis is considered to still be active. When this datatype is used with timing relationships, the criterion is looking for an active diagnosis for the time frame indicated by the timing relationships. Timing: The Prevalence Period references the time from the onset date to the abatement date.
      Value Set Description from VSAC:
      This value set contains concepts related to visits for assessments for neuropsychological assessments.
      This value set may use QDM category Encounter.
      Includes applicable neuropsychological assessments for behavioral health.
      No exclusions.

      Constrained to codes in the Behavioral/Neuropsych Assessment value set (2.16.840.1.113883.3.526.3.1023)

      QDM Datatype - Encounter Performed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time). stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location.
      Value Set Description from VSAC:
      This value set identifies patients living in assisted living, domiciliary care or rest homes who have had an interaction with a member of their medical team.
      This value set is developed for the encounter QDM datatype. It can potentially be used for other datatypes as well.
      Includes services provided to new and established patients living in assisted living, domiciliary care or rest home.
      Excludes visits in settings other than assisted living, domiciliary care or rest homes

      Constrained to codes in the Care Services in Long-Term Residential Facility value set (2.16.840.1.113883.3.464.1003.101.12.1014)

      QDM Datatype - Encounter Performed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time). stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location.
      Value Set Description from VSAC:
      This value set identifies patients who have had a home health visit by a provider for the evaluation or management of a new or existing patient.
      This value set was intended to map to the QDM data type of encounter.
      Include all home visits for the evaluation and management of a new or established patient.
      None

      Constrained to codes in the Home Healthcare Services value set (2.16.840.1.113883.3.464.1003.101.12.1016)

      QDM Datatype - Encounter Performed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time). stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location.
      Value Set Description from VSAC:
      This value set identifies patients who have had an interaction with a member of their medical team on admission to a nursing facility.
      This value set is developed for the encounter QDM datatype. It can potentially be used for other datatypes as well.
      Includes services provided to new and established patients in a nursing facility (skilled, intermediate and long-term care facilities).
      Excludes visits in settings other than a nursing facility.

      Constrained to codes in the Nursing Facility Visit value set (2.16.840.1.113883.3.464.1003.101.12.1012)

      QDM Datatype - Encounter Performed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time). stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location.
      Value Set Description from VSAC:
      This value set contains concepts related to visits for evaluations for occupational therapy services.
      This value set may use QDM category Encounter.
      Includes all applicable codes for Occupational Therapy evaluations.
      No exclusions.

      Constrained to codes in the Occupational Therapy Evaluation value set (2.16.840.1.113883.3.526.3.1011)

      QDM Datatype - Encounter Performed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time). stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location.
      Value Set Description from VSAC:
      This value set identifies patients who have had an office or other outpatient visit.
      This value set was intended to map to the QDM data type of encounter.
      Includes comprehensive history, evaluation, and management of a patient in an office or outpatient facility. Patient can be presenting with problems that are minor to high severity.
      Excludes non-office visits, including telehealth services.

      Constrained to codes in the Office Visit 1 value set (2.16.840.1.113883.3.464.1003.101.12.1001)

      QDM Datatype - Encounter Performed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time). stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location.
      Value Set Description from VSAC:
      This value set identifies patients who have had an outpatient interaction at an office with a member of their medical care team.
      This value set was intended to map to the QDM data type of encounter.
      Includes comprehensive history, evaluation, and management of a patient in an office or outpatient facility. Patient can be presenting with problems that are minor to high severity.
      Excludes non-office visits, including telehealth services.

      Constrained to codes in the Outpatient Consultation value set (2.16.840.1.113883.3.464.1003.101.12.1008)

      QDM Datatype - Encounter Performed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time). stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location.
      Value Set Description from VSAC:
      This value set contains concepts related to provider interactions with patients that include both face-to-face and virtual types of encounters.
      This value set may use QDM category Encounter.
      Includes provider interactions with patients that are conducted in an office or care setting, as well as interactions which may occur via virtual methods, such as telephone calls, emails, and letters.
      Under No exclusions.

      Constrained to codes in the Patient Provider Interaction value set (2.16.840.1.113883.3.526.3.1012)

      QDM Datatype - Encounter Performed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time). stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location.
      Value Set Description from VSAC:
      This value set contains concepts related to visits during which a psychiatric diagnostic evaluation is completed.
      This value set may use QDM category Encounter.
      Includes applicable concepts for visits with the completion of psychiatric diagnostic evaluations.
      No exclusions.

      Constrained to codes in the Psych Visit - Diagnostic Evaluation value set (2.16.840.1.113883.3.526.3.1492)

      QDM Datatype - Encounter Performed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time). stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location.
      Value Set Description from VSAC:
      This value set contains concepts related to visits for psychotherapy.
      This value set may use QDM category Encounter.
      Includes visits for individual psychotherapy services.
      Does not include group psychotherapy or family psychotherapy.

      Constrained to codes in the Psych Visit - Psychotherapy value set (2.16.840.1.113883.3.526.3.1496)

      QDM Datatype - Encounter Performed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time). stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location.
      Value Set Description from VSAC:
      This value set contains concepts related to assessments performed for the evaluation of cognition.
      This value set may use QDM category Intervention.
      Includes general concepts for assessments used to evaluate cognition.
      Does not include standardized tools used to evaluate cognition.

      Constrained to codes in the Cognitive Assessment value set (2.16.840.1.113883.3.526.3.1332)

      QDM Datatype - Intervention Performed: Data elements that meet criteria using this datatype should document the completion of the intervention indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: startTime – The time the intervention begins. stopTime – The time the intervention ends. NOTE - timing refers to a single instance of an intervention. If a measure seeks to evaluate multiple interventions over a period of time, the measure developer should use CQL logic to represent the query request.
      Value Set Description from VSAC:
      Gender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories.
      Gender
      Male and Female only.
      Any gender identity that is not male or female.

      Constrained to codes in the ONC Administrative Sex value set (2.16.840.1.113762.1.4.1)

      QDM Datatype - Patient Characteristic Sex: Data elements that meet criteria using this datatype should document that the patient's sex matches the QDM category and its corresponding value set. Timing: Birth (administrative) sex does not have a specific timing.
      Value Set Description from VSAC:
      n/a n/a n/a n/a

      Constrained to codes in the Ethnicity value set (2.16.840.1.114222.4.11.837)

      QDM Datatype - Patient Characteristic Ethnicity: Data elements that meet criteria using this datatype should document that the patient has one or more of the ethnicities indicated by the QDM category and its corresponding value set. Timing: Ethnicity does not have a specific timing. Measures using Patient Characteristic, Ethnicity should address the most recent entry in the clinical record.
      Value Set Description from VSAC:
      Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system
      @code in CCDA r2.1 template Planned Coverage [act: identifier urn:oid:2.16.840.1.113883.10.20.22.4.129 (open)] DYNAMIC
      All codes in the code system
      None

      Constrained to codes in the Payer value set (2.16.840.1.114222.4.11.3591)

      QDM Datatype - Patient Characteristic Payer: Data elements that meet criteria using this datatype should document that the patient has one or more of the payers indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: startTime – The first day of insurance coverage with the referenced payer. stopTime – The last day of insurance coverage with the referenced payer.
      Value Set Description from VSAC:
      n/a n/a n/a n/a

      Constrained to codes in the Race value set (2.16.840.1.114222.4.11.836)

      QDM Datatype - Patient Characteristic Race: Data elements that meet criteria using this datatype should document the patient’s race. Timing: Race does not have a specific timing. Measures using Patient Characteristic, Race should address the most recent entry in the clinical record.
      Value Set Description from VSAC:
      This value set contains concepts related to patient-specific reasons for when a patient does not receive a therapy or service.
      This value set may be used as an attribute.
      Includes concepts related to patient-specific reasons for not receiving a therapy or service.
      No exclusions.

      Constrained to codes in the Patient Reason value set (2.16.840.1.113883.3.526.3.1008)

      QDM Attribute - Negation Rationale: Indicates the reason that an action was not performed. Only QDM datatypes that represent actions (e.g., performed, recommended, communication, order, dispensed) allow the “negation rationale” attribute. The intent is to indicate a justification that such action did not happen as expected. This attribute specifically does not address the presence or absence of information in a clinical record (e.g., documented absence of allergies Vs lack of documentation about allergies). The syntax in the human readable HQMF is address in CQL examples and in the MAT User Guide. Prior versions of QDM used the syntax, “Procedure, Performed not done.” QDM 5.0 DRAFT uses the syntax, “Procedure, not Performed.” Note: Some datatypes include both Relevant Time and Author dateTime attributes. The purpose is to accommodate Author dateTime if the actual start and stop times are not available when evaluating for feasibility, and also to allow specification of a time for Negation Rationale.