Screening for Perinatal Depression

November 30, 2004

To: Participating Physicians, Nurse Practitioners, Nurse Midwives, General Hospitals, Federally Qualified Health Centers, Encounter Rate Clinics, Rural Health Clinics, Certified Health Departments, and School Based/Linked Centers

Re: Screening for Perinatal Depression

The state's human services agencies, the Illinois Departments of Healthcare and Family Services (HFS), Public Health (DPH), Human Services (DHS), Children and Family Services (DCFS), Department of Corrections (DOC) and the Conference of Women Legislators, in coordination with the University of Illinois at Chicago (UIC) Women's Mental Health Program, are working together to address perinatal depression with the ultimate goal of improving maternal and child health outcomes through screening, identification, referral and treatment of this illness.

This notice provides information on HFS initiation of reimbursement for screening for perinatal depression and information about consultation services available to providers. The Information for Physicians on Prescription Products to Treat Perinatal Depression (July 2004) can also be found on the HFS Web site.

Medicaid covers over 40 percent of Illinois births each year, and an estimated 66 percent of those births are unintended. Medicaid covers approximately 89 percent of teen births in Illinois. It is estimated that 10-20 percent of women in the United States who give birth experience a major depression within six months of delivery, with the occurrences substantially higher in women with low socioeconomic status.

Perinatal depression may occur at any time during the pregnancy, immediately after delivery, or even up to one year after delivery. The consequences of untreated perinatal depression can be devastating and have long-term adverse effects for the woman, her child and other family members. Yet, perinatal depression remains both under recognized and under treated. Early detection of symptoms and prompt initiation of treatment can greatly reduce adverse consequences. Medications and psychosocial interventions can effectively treat depression both during pregnancy and the postpartum period.

HFS provides reimbursement for "risk assessment" for children and pregnant women. Effective with dates of service on or after December 1, 2004, reimbursement will be available for perinatal depression screening as a "risk assessment" to identify women who may be at risk of, or who are experiencing, perinatal depression. A list of risk factors for identifying women who may be at risk of prenatal or postpartum (perinatal) depression is available on HFS Web site. Often, risk factors may not be evident and depression may not be apparent without specific screening.

HFS has reviewed the Edinburgh Postnatal Depression Scale (EPDS) and finds it to be an appropriate tool for screening pregnant and postpartum women for perinatal depression. Used with the woman's prior knowledge and consent, the EPDS is a reliable scale that is recognized as an appropriate screening instrument for early identification of depression during both the prenatal and postpartum periods. The EPSD contains ten questions and can usually be quickly administered and scored. A copy of the EPDS and its scoring guidelines can be found on HFS Web site. Other screening tools that have been validated for use in obstetric populations may also be used to conduct perinatal "risk assessment" for women covered by HFS Medical Programs. These include the Beck Depression Inventory and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire see Illinois Chapter, American Academy of Pediatrics Web site for more information on these tools). Prior to using a perinatal depression screening instrument other than the EPDS, the Beck Depression Inventory or the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire, the provider must obtain written approval from HFS in order to obtain reimbursement for the screening. Requests must be submitted in writing to HFS Maternal and Child Health Program and include documentation that the screening instrument has been formally validated, is nationally distributed, and is individually administered. Please be aware that reimbursement will only occur for screenings using one of the listed and approved tools.

Enrolled physicians and other providers performing primary care services may complete a perinatal depression screening during a prenatal or postpartum visit, or during an infant well-child or episodic visit. Family Case Management (FCM) agencies that are certified local health departments will be reimbursed by HFS for depression screening. FCM agencies may complete a screening during a face-to-face case management or WIC encounter.

Encounter Rate Clinics (ERCs), Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) will not receive separate reimbursement for perinatal depression screenings because ERCs, FQHCs and RHCs are paid an encounter rate that encompasses all services provided during an encounter. ERCs, FQHCs and RHCs should, however, include the appropriate "risk assessment" procedure code on the encounter claim. The screening can be performed during a medical or a behavioral health encounter (for those enrolled to provide behavioral health services).

Reimbursement is available for both prenatal and postpartum depression screening, as a "risk assessment." The current reimbursement rate for procedure codes H1000 and 99420 is $14.60. Information about HFS reimbursement rates is available on HFS Web site.

When billing for prenatal depression screening, use procedure code H1000.

If the woman is postpartum and covered by HFS Medical Programs, the perinatal depression screening should be billed using procedure code 99420 with modifier HD (pregnant/parenting women's program) under the woman's Recipient Identification Number (RIN). Maintain the results and copy of the screening instrument in the mother's file.

If the postpartum depression screening occurs during a well-child visit or episodic visit for an infant (under age one) covered by HFS Medical Programs, the screening may be billed as a "risk assessment" using procedure code 99420 with modifier HD (pregnant/parenting women's program) under the infant's RIN. Record this screening as a "risk assessment" in the infant’s record. Maintain the results and copy of the screening instrument in a separate file, not in the infant's file. For record keeping suggestions, visit Illinois Chapter, American Academy of Pediatrics Web site.

A statewide Perinatal Mental Health Consultation Service has been established for providers to use when a screening indicates that a pregnant or postpartum woman may be suffering from depression. This service provides consultation with psychiatrists, and information about medications that may be used in the management of perinatal depression both during and after pregnancy.

The Perinatal Mental Health Consultation Service toll-free telephone number is 1-800-573-6121.

Provider and patient-focused information and resources are available on HFS Web site. The site provides links to other state agencies, helplines and sources for more information. The Web site also includes a brochure that may be downloaded and copied for distribution to patients. Patients may also be referred to the DHS Helpline at 1-800-843-6154 or TTY 1-800-447-6404 for additional resource information.

Provider associations partnering in this effort are the Illinois Chapter, American College of Obstetrics and Gynecology (ACOG); the Illinois Chapter, American Academy of Pediatrics (ICAAP) and the Illinois Academy of Family Physicians (IAFP). For more information, please visit the ICAAP Web site or the IAFP Web site.

To reduce copying and mailing cost, the department may not always include hardcopies of attachments referenced in notices and bulletins. Web site links will be identified so providers may view and print the material from the Internet. Providers wishing to receive E-mail notification, when new provider information has been posted by the department, may register on the HFS Web site

For questions regarding the Maternal and Child Health Program please contact HFS Bureau of Maternal and Child Health Promotion at 217-524-7478. For billing related questions, please contact HFS Bureau of Comprehensive Health Services at 1-877-782-5565.

Anne Marie Murphy, Ph.D.
Administrator
Division of Medical Programs

Provider Endorsement Letter