Coding for Perinatal Depression

Screening for Depression

If a physician is providing the global obstetrical service (and reporting a global code), the payer may consider screening for depression as part of the global service and not reimburse additionally for the service. This is particularly true if the physician screens every patient for depression as routine. However, some payers may reimburse for this service. Physicians should check with their specific payers.

Treatment for Patients with Signs and Symptoms

If the patient has signs or symptoms of depression (reported with an appropriate diagnosis code), then those services are reported separately from the global service and may potentially be reimbursed.

Diagnosis Coding

Mental, behavioral, and neurodevelopmental disorder codes are found in Chapter 5, Mental, Behavioral, and Neurodevelopmental Disorders, code block (F01-F99), of ICD-10-CM. Note that many payers will only reimburse a psychiatrist or psychologist for services linked to a diagnosis in the mental disorders chapter.

The possible ICD-10-CM diagnosis codes are as follows: ­

• F05 Delirium due to known physiological condition ­
• F30 Manic episode ­
• F34.1 Dysthymic disorder ­
• F32.9 Major depressive disorder, single episode, unspecified

Other diagnoses that may be reported may be found in the signs and symptoms and nervous system chapters. Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified, code block (R00-R99), are found in Chapter 18 of ICD-10-CM. Sleep disorders are found in Chapter 6, Diseases of the Nervous System, code block (G00-G99), sub code section G40-G47: Episodic and paroxysmal disorders.

Additional possible ICD-10-CM codes are as follows: ­

• G47.9 Sleep disorder, unspecified ­
• R53.81 Other malaise ­
• R53.83 Other fatigue ­
• R45 Symptoms and signs involving emotional state

Procedure Coding

The correct evaluation and management code will depend on whether the encounter was for screening or treatment of depression.

If the encounter was for screening for a patient without symptoms, report a preventive medicine code. These codes are selected according to the time spent in face-to-face counseling with the patient. Whether or not these codes will be reimbursed by the payer will vary. Possible procedure codes are: ­

• 99401-99404 Preventive medicine, individual counseling ­
• 99411-99412 Preventive medicine, group counseling

If the encounter was for treatment for a patient with a diagnosis of depression or documented symptoms of depression, report an office or other outpatient evaluation and management code. These codes list a typical time in the code descriptions. Time spent face to face counseling the patient must be documented in the medical record. The record must document that either all of the encounter or more than 50% of the total time was spent counseling the patient. Possible procedure codes are: ­

• 99201-99205 New patient, office or other outpatient visit ­
• 99211-99215 Established patient, office or other outpatient visit