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Assessment and Diagnosis of Mental Health Conditions in the Primary Care Setting

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.


Clinical Depression Screening and Follow-Up

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).

Standardized Depression Screening Tools

Patient Health Questionnaire 9 (PHQ9)

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 on the SAMHSA website at https://www.integration.samhsa.gov/clinical-practice/screening-tools

Note: Clinician should rule out for physical causes of depression, normal bereavement, or history of manic/hypomanic episode.

Edinburgh Postnatal Depression Scale

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%20Depression%20Scale.pdf

Note: Molina offers Maternity Case Management support. Contact Molina Case Management for more information.

Clinical Depression Screening Codes and Documentation

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

ICD 10 codes capture current symptoms, severity, and onset

MDD, Single Episode Mild: F32.0

MDD, Recurrent Episode Mild: F33.0

Documenting the Follow-Up Plan

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:

  • Additional evaluation.
  • Suicide risk assessment.
  • Referral to a practitioner who is qualified to diagnose and treat depression.
  • Pharmacological interventions.
  • Other interventions or follow-up for the diagnosis of depression.

The documented follow-up plan must be related to positive depression screening, for example: “Patient referred for psychiatric evaluation due to positive depression screening.”

Exclusion Codes and Documentation

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

Documenting Exclusions

A patient is not eligible if one or more of the following conditions are documented in the patient’s medical record:

  • Patient has an active diagnosis of Depression or Bipolar Disorder.
  • Patient refuses to participate.
  • Patient is in an urgent or emergent situation where time is of the essence and to delay the patient’s treatment would jeopardize the patient’s health status.
  • Situations where the patient’s functional capacity or motivation to improve may impact the accuracy of the screening tool. For example, court-appointed cases or cases of delirium.

Case Scenario

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
RAMP.Operations@MolinaHealthCare.Com