Provider Alert! Coding Changes to Postpartum Depression Screening
Maternal depression is a serious and prevalent condition that not only affects the mother, but may present a substantial early risk to appropriate child development, the mother-infant bond, and the family. According to the AAP, it has been estimated that 5 percent to 25 percent of all pregnant, postpartum, and parenting women have some type of depression. Mothers who have low incomes are more likely to experience some form of depression than the general population of mothers. A maternal depression screening can be considered an essential part of a risk assessment for the child, given the evidence that maternal depression can place children at risk of adverse health consequences.
Effective for dates of service on or after July 1, 2018, postpartum depression screening is a payable benefit of Texas Medicaid utilizing procedure codes G8431 and G8510. The new billing codes will replace code 96161 as a benefit for maternal depression screening conducted at a well-child visit. 96161 will no longer be payable for maternal depression screening effective 10/1/18.
- G8431 = Screening for depression is documented as being positive and a follow-up plan is documented
- G8510 = Screening for depression is documented as negative, a follow-up plan is not required
The reimbursement amount for procedure codes G8431 and G8510 covers all postpartum depression screenings provided during the infant’s medical checkups or follow-up visits. Only one procedure code, either G8431 or G8510, may be reimbursed per provider in the 12 months following the infant’s birth, but may be billed for tracking purposes whenever conducted.
Postpartum depression screening must be submitted under the infant’s Medicaid number and will be restricted to members who are 12 months of age and younger. Screening and referral is not contingent upon the mother’s Medicaid eligibility.
Procedure codes G8431 and G8510 must be submitted on the same claim, for the same date of service and provider, as one of the following Texas Health Steps medical checkup or follow-up visit procedure codes:
| 99211 | 99381 | 99382 | 99391 | 99392 |
Screening using a validated tool is required. At a minimum, screening should occur at least once during the postpartum period. Validated tools may include the following:
- Edinburgh Postnatal Depression Scale
- Postpartum Depression Screening Scale
- Patient Health Questionnaire 9
Documentation in the infant’s medical record must include the name of the screening tool used and the date screening was completed.
If the mother screens positive for depression, at a minimum, the provider must note that a referral plan was discussed with the mother and a referral to an appropriate provider was made.
Providers should discuss the screening results with the mother, including the possibility of depression and the impact depression may have on the mother, family, and health of the infant. Scheduling a return visit for the infant, sooner than the next scheduled visit, may be appropriate in some cases.
Screening for postpartum depression does not require that the child’s provider treat the mother. However, the child’s provider has a role in supporting the mother and facilitating her access to resources to optimize the child’s healthy development and the healthy functioning of the family. Mothers who screen positive for postpartum depression may be referred to:
- Mental health clinicians;
- The mother’s primary care provider;
- Obstetricians and gynecologists;
- Family physicians; and/or
- Community resources such as local mental health authorities.
Resources for support in the interim should be provided until the mother is able to access care.
National hotlines are available to provide guidance for treatment:
Postpartum Support International Warmline
Phone Number: 1-800-944-4PPD (4773)
Website: www.postpartum.net
PPD Moms
Phone Number: 1-800-PPD-MOMS (1-800-773-6667)
Email: info@hopeline.com
Website: http://www.1800ppdmoms.org/
Providers may access the Edinburgh Postnatal Depression Scale online at no cost:
English: https://www2.aap.org/sections/scan/practicingsafety/Toolkit_Resources/Module2/EPDS.pdf
Spanish: http://www.cdph.ca.gov/programs/mcah/Documents/MO-CHVP-EPDS-Spanish.pdf
For additional information:
AAP Clinical Report – Incorporating Recognition and Management of Perinatal and Postpartum Depression Into Pediatric Practice accessible at http://pediatrics.aappublications.org/content/pediatrics/early/2010/10/25/peds.2010-2348.full.pdf
CMS Informational Bulletin – Maternal Depression Screening and Treatment: A Critical Role for Medicaid in the Care of Mothers and Children accessible at
https://www.medicaid.gov/federal-policy-guidance/downloads/cib051116.pdf
The Texas Clinician’s Postpartum Depression Toolkit
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