There was a handwritten note which noted that the patient complained of poor memory and focus. There was a letter by the ordering physician appealing the denial of coverage for testing for MTHFR gene mutation and advanced lipoprotein testing. He noted that the patient suffered from anxiety, depression, chronic pain, poor concentration, and poor memory. He noted that the patient had a strong family history of dementia in both parents. He noted that his opinion was that the requested tests were necessary.

The scientific evidence in peer-reviewed literature supports a result of improvement in health outcomes. For example, treating hyperhomocysteinemia had resulted in slowing progression of cognitive decline. The patient has a memory complaint and first degree relatives with dementia. These tests might help give added information regarding her modifiable risk factors for dementia. Therefore, the scientific evidence in peer-reviewed literature does support a result of improvement in health outcome.

As noted in current peer literature, there is an international consensus statement that treating hyperhomocysteinemia is beneficial.

Per Licking N, Murchison C, et al. (2017), "We conclude that plasma homocysteine [HC] is significantly associated with some aspects of cognitive function in Parkinson's Disease [PD], and may represent a treatable risk factor for cognitive decline in PD."

This patient is a good candidate for CPT codes 81400 & 81401; and genetic test, CPT code 81291; date of service 6/30/18. The patient has a memory complaint and first degree relatives with dementia and these tests might help give added information regarding her modifiable risk factors for dementia. The testing is the best available treatment for this patient at this time as it can check for modifiable risk factors for dementia. Additionally, it is likely to be more beneficial than any standard treatment/procedures for this patient.