This HEDIS® measure reviews the percentage of deliveries in which members were screened for clinical depression while pregnant and, if screened positive, received follow-up care. Two rates are reported:
  • Depression screening: the percentage of deliveries in which members were screened for clinical depression during pregnancy using a standardized instrument with recorded result.
  • Follow-up on positive screen: the percentage of deliveries in which members received any of the following follow-up care on or up to 30 days of a positive depression screen finding:
    • An outpatient, telephone, e-visit, or virtual check-in follow-up visit with a diagnosis of depression or other behavioral health condition.
    • A depression case management encounter that documents assessment for symptoms of depression or a diagnosis of depression or other behavioral health condition.
    • A behavioral health encounter, including assessment, therapy, collaborative care, or medication management.
    • A dispensed antidepressant medication.
  • Documentation of additional depression screening on a full-length instrument indicating either no depression or no symptoms that require follow-up (for example, a negative screen) on the same day as a positive screen on a brief screening instrument.

Note: For example, if there is a positive screen resulting from a PHQ-2 score, documentation of a negative finding from a PHQ-9 performed on the same day qualifies as evidence of follow-up.

 

*Scoring included in this bulletin does not override clinical judgment and all positive answers to suicidality should be discussed.

 

Exclusions:

  • Deliveries that occurred at less than 37 weeks gestation
  • Deliveries in which members were in hospice or using hospice services

 

Specified standardized assessment instruments by age group and thresholds for positive findings:

 

Instruments for adolescents (12 to 17 years)

Positive finding

Patient Health Questionnaire (PHQ-9)®

Total score ≥ 10

Patient Health Questionnaire Modified for Teens (PHQ-9M)®

Total score ≥ 10

Patient Health Questionnaire-2 (PHQ-2)® 1

Total score ≥ 3

Beck Depression Inventory-Fast Screen (BDI-FS)® 1, 2, 3

Total score ≥ 8

Center for Epidemiologic Studies Depression Scale-Revised (CESD-R)

Total score ≥ 17

Edinburgh Postnatal Depression Scale (EPDS)

Total score ≥ 10

PROMIS Depression

Total score (T Score) ≥ 60

 

Instruments for adults (18+ years)

Positive finding

Patient Health Questionnaire (PHQ-9)®

Total score ≥ 10

Patient Health Questionnaire-2 (PHQ-2)® 1

Total score ≥ 3

Beck Depression Inventory-Fast Screen (BDI-FS)® 1, 2

Total score ≥ 8

Beck Depression Inventory (BDI-II)

Total score ≥ 20

Center for Epidemiologic Studies Depression Scale-Revised (CESD-R)

Total score ≥ 17

Duke Anxiety-Depression Scale (DADS)® 2

Total score ≥ 30

Edinburgh Postnatal Depression Scale (EPDS)

Total score ≥ 10

My Mood Monitor (M-3)®

Total score ≥ 5

PROMIS Depression

Total score (T Score) ≥ 60

Clinically Useful Depression Outcome Scale (CUDOS)

Total score ≥ 31

 

Description

Codes

Diagnosis: Deliveries

37 to 43 weeks gestation

CPT: 59400, 59409, 59410, 59510, 59514, 59515, 59610, 59612, 59614, 59618, 59620, 59622

ICD-10: Z3A.37, Z3A.38, Z3A.39, Z3A.40, Z3A.41, Z3A.42, Z3A.49

ICD-10 PCS: 10D00Z0, 10D00Z1, 10D00Z2, 10D07Z3, 10D07Z4, 10D07Z5, 10D07Z6, 10D07Z7, 10D07Z8, 10E0XZZ

 

Description

LOINC

Beck Depression Inventory Fast Screen total score

89208-3

Beck Depression Inventory II total score

89209-1

Center for Epidemiologic Studies Depression Scale-Revised total score

89205-9

Edinburgh Postnatal Depression Scale total score

71354-5

My Mood Monitor Total score

71777-7

Patient Health Questionnaire 2 item (PHQ-2) total score

55758-7

Patient Health Questionnaire 9 item (PHQ-9) total score

44261-6

Patient Health Questionnaire 9: Modified for teens total score

89204-2

PROMIS 29 Depression score total score

71965-8

Clinically Useful Depression Outcome Scale (CUDOS) total score

90221-3

Duke Anxiety-Depression Scale (DADS) total score

90853-3

 

Description of findings/results

HCPCS

Screening for depression is documented as negative; a follow-up plan is not required

G8510

Screening for depression is documented as being positive, and a follow-up plan is documented

G8431

Screening for depression documented as positive, follow-up plan not documented, reason not given

* Use of code not recommended

G8511

 

How can we help?

Members are eligible for transportation assistance at no cost. Contact member services at 844-772-6632 Monday through Friday, 8 a.m. to 8 p.m. Eastern time.

 

Helpful tips:

If utilizing an electronic medical record (EMR) system, consider electronic data sharing with your health plan to capture all coded elements. Contact your quality representative for additional details and answers to questions.

Optimize your charting system to prompt your providers to perform any of the specified prenatal depression screening tools at the first prenatal visit as part of your standard initial prenatal exam.

 

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

 

1 Brief screening instrument. All other instruments are full-length.

2 Proprietary; cost or licensing requirement may be associated with use.

3 Approved only for ages 13 years and older.

 

AINPEC-3354-21



Featured In:
November 2021 Anthem Provider News - Indiana