If you suspect bipolar disorder, schizophrenia or other psychotic disorders, refer your patient to a Molina Healthcare-affiliated Behavioral Health or Substance Use Disorder Specialist. Contact Molina Healthcare (see Contact Information at the beginning of this handbook) for referral assistance for these or any mental health conditions that require evaluation or treatment by a specialist.
According to the CDC, rates of any symptom of depression were highest among adults aged 18-29 (21.0%), followed by those aged 45-64 (18.4%) and 65 and over (18.4%), and lastly, by those aged 30-44 (16.8%).
The Centers for Medicare & Medicaid Services REQUIRES enrollees in Medicare-Medicaid Plans (also known as ‘Dual Eligible’) to be screened for Depression on an annual basis using a standardized depression-screening tool. Members age 18 and older who complete a physical or behavioral health outpatient visit must complete depression screening even in the absence of symptoms. Providers are encouraged to conduct annual Depression screening for ALL Molina members.
Depression is common and impacts 15.8 million adults in the United States. Your patient’s symptoms may manifest in various ways including increase in anxiety, feeling sad most of the time, or even a change in the amount of food or substances taken. Major depression affects your patient’s life in multiple settings (for example, school, work, relationships).
Molina endorses the use of the PHQ-9 (Patient Health Questionnaire 9) Questions, a standardized depression screening tool with established clinical validity. The PHQ-9 screening tool, scoring instructions and description of depression risk levels (low/maintenance level); moderate; high/severe can be found at https://www.depression-primarycare.org/clinicians/toolkits/materials/forms/phq9/
The Edinburgh Postnatal Depression Scale (EPDS) is a standardized depression screening tool to screen postpartum women in the outpatient setting. The EPDS is a screening tool with scoring instructions and description of depression risk levels and is not intended to diagnose depression. The EPDS can be found on the American Academy of Pediatrics website at https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/practicing-safety/Documents/Postnatal-Depression-Scale
G8431: Screening for clinical depression is documented as being positive and a follow-up plan is documented.
G8510: Screening for clinical depression is documented as negative. A follow-up plan is not required as patient not eligible/appropriate for follow-up.
ICD 10 codes capture current symptoms, severity, and onset
MDD, Single Episode Mild: F32.0
MDD, Recurrent Episode Mild: F33.0
The follow-up plan is the proposed outline of treatment to be conducted as a result of clinical depression screening. Follow-up for positive depression screening must include one (1) or more of the following:
The documented follow-up plan must be related to positive depression screening, for example: “Patient referred for psychiatric evaluation due to positive depression screening.”
G8433: Screening for clinical depression not documented. Medical record documents that the patient is not eligible/appropriate.
G8940: Screening for clinical depression is documented. Medical record documents that the patient is not eligible/appropriate
A patient is not eligible if one or more of the following conditions are documented in the patient’s medical record:
73 year old female with many known episodes of Major Depression now complaining of worsening symptoms including increased loss of interest in activities, hypersomnia, increased tearfulness and sadness. Denies thoughts of self-harm.
Assessment and Diagnosis: Patient diagnosed with Major Depression, Recurrent, Unspecified; current symptoms not controlled (F33.9, Major Depressive Disorder, Recurrent, Unspecified).
Plan: Increase SSRI dosage and follow-up in 14 days with mental health counselor.
**For specific Risk Adjustable codes related to Major Depression, contact
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