Use arrow keys to move forward or backward through presentation This is the Rivermead Post-Concussion Symptoms Questionnaire The Patient must fill this form out on the 2nd visit to the office if… the Symptoms form has boxes checked indicating a cognitive problem Use arrow keys to move forward or backward through presentation

Cognition The human-like processing of information, applying knowledge and changing preferences. Think of the word “Recognize”, which is to know something when you see it for a 2nd time, so it literally means to “cognize” again. Cognition is the ability of the brain to process information and use the knowledge that the brain has in it. A cognition problems means the brain cannot process information (concentrate) or apply the knowledge (forgetfulness, taking longer to think).

Here is how you know when to use the Rivermead See where the Symptoms form has boxes checked indicating Difficulty Concentrating, Blurry Vision, Disorientation, Difficulty Focusing, Can’t Remember Numbers, Poor Attention, Difficulty Remembering, Re-Reading Things, Difficulty Making Decisions, and Difficulty Planning. Any one of these will cause you to use the Rivermead Form to evaluate the patient’s cognitive problem.

The AMA Guides to the Evaluation of Permanent Impairments, 5th Edition (used by Colossus) says: “A paroxysmal disorder (of thinking) with pre-impairment exists, but (the patient) is able to perform activities of daily living.” Paroxysmal meanings “intermittent”

The AMA Guides to the Evaluation of Permanent Impairments, 5th Edition (used by Colossus) says: “Poor short-term memory, inability to balance checkbook, inability to calculate, failure to follow through on instructions” are signs of a permanent impairment for the brain for Mental State & Cognition” A 1% to 14% impairment is made for people who have some 2’s and 3’s circled on this form.

Have the patient fill this out on day 2 if there are symptoms of abnormal “cognition” Repeat at every re-exam, including the final exam so long as the patient does not score all Zero’s and 1’s

Use the Rivermead along with the Folstein Exam Form Together, they are a “cognition screening evaluation.” If the patient still has problems with cognition when released, have the MD do a permanent impairment for Mental State and Cognition.

90801 90801-59 Use this CPT code to bill for the Neuropsych consultation screening evaluation called Rivermead. Typical fees are about $95 for this CPT code. The -59 modifier tells the insurance company that you did a separate Evaluation and Management on the same day as you did treatment (adjustments, therapies).

In Summary… The Rivermead Form is filled out Day 2 initially, at re-exams & at final exam. There will be 3 to 6 of these when you are ready to write the narrative report. If the patient has several 2’s and 3’s when ready to be released, have an MD give an impairment rating for abnormal “cognition”.

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