Screening and Management for Clinical Depression

Blue Cross and Blue Shield of New Mexico (BCBSNM) encourages providers to complete annual depression screening for members and increase the percentage of members who remain on antidepressant medications consistent with evidence-based practice guidelines. Providers should consider an annual screening for Blue Cross Community Centennial^SM members who are 18 years of age or older without an active diagnosis of depression, bipolar disorder, or other mood symptoms. Patients in an urgent or emergent situation where a delay in treatment may jeopardize the patient’s health status may not be clinically indicated for depression screening.

The Patient Health Questionnaire – 9 (PHQ-9) is a depression screening tool that can be completed by patients in the office and is easily accessible in multiple languages at www.phqscreeners.com .

Did you know?

• BCBSNM reimburses providers that participate in the Blue Cross Community Centennial network for administering an annual depression screening tool using procedure code G0444 (administration).
• Results are reported simultaneously with either G8431 (positive screen with plan) or G8510 (negative screen) result code. Through December 31, 2018, additional reimbursement will be provided for G8431 and G8510. Add the modifier, U8, in the modifier section on the CMS 1500 when submitting the claim that includes G0444 with the addition of either G8431 or G8510. Any reimbursement will be made according to Blue Cross Community Centennial medical/reimbursement policies for services and other billing and reimbursement practices.

Medication Management and Adherence Improvement Strategies Recommended by the American Psychiatric Association (APA).^*

• The provider should assess and acknowledge potential barriers to treatment adherence, including lack of motivation, side effects of treatment, logistical, economic or cultural barriers to treatment.
• The provider should collaborate with the patient (and if possible the family) to minimize the impact of these potential barriers.
• Patients should be given realistic expectations during the different phases of treatment, including the time course of symptom response and the importance of adherence for successful treatment.
• Misperceptions, fears and concerns about antidepressants should be addressed with the patient
• Education should be provided about major depression, the risk of relapse and the early recognition of recurrent symptoms.
• Patients should be informed about the need to taper antidepressants rather than discontinuing them prematurely.
• Common side effects of antidepressants should be discussed with the patient. The provider should encourage the patient to identify side effects they would consider reasonable and those they would consider unbearable.
• Providers should explain when and how to take the medication, reminder systems, information about continuing the medication after symptoms of depression improve, strategies to incorporate medication into the daily routine, and minimizing the cost of antidepressant regimens to improve adherence.

Psychotherapy is also a recommended treatment for depression, and a referral is often the appropriate treatment for mild situational blue moods (or adjustment disorders).

^*“Practice Guideline for the Treatment of Patients with Major Depressive Disorder 3rd Edition” (2010). APA Practice guidelines are meant to serve as general guidelines and are not intended to substitute for clinical judgment in individual cases.