Depression Management

Assess for Depression

Effective treatment begins with a thorough evaluation of the patient and accurate diagnosis. Screening tools can be helpful to identify depression. The use of DSM-IV criteria is essential to an accurate diagnosis. When depression is identified, remember to code the diagnosis appropriately on claim submissions.

For Example:

• 296.20 Major Depression, Single Episode
• 296.30 Major Depression, Recurrent

Select Appropriate Therapeutic Modality

Choosing the appropriate treatment for each individual patient is critical to treatment outcomes. While medications can work well in moderate to severe clinical depression, psychotherapy may be considered an effective alternative in treating mild depression. When prescribing antidepressant medication, consider using a medication on the formulary when appropriate to help minimize the expense for the patient.

Provide Medication Information

A number of studies have shown patients’ lack of understanding about the disease of depression, onset of therapeutic effect of medication, and their concerns about the risk of medications are significant causes of medication discontinuation. Provider discussions to inform patients about depression in a collaborative treatment environment can significantly improve treatment adherence and outcome. Explain the expected duration of medication therapy. Depression guidelines from the American Psychiatric Association and others highlight the appropriateness of continuing medication for 6-9 months. Educate patients that it usually takes at least 2-4 weeks before any therapeutic effectiveness of the medication is observed.

Follow-Up Appointments for Monitoring Treatment Response

For medication monitoring, there should be a minimum of three follow-up visits within the first 12 weeks of treatment (HEDIS® 2003 measures). Depression scales can be used for monitoring therapeutic treatment progress. For more information on diagnosing and treating depression, see our Primary Care Clinical Guidelines for Depression.

Reimbursement

Claims for office visits related to medication management with a behavioral diagnosis billed by a participating provider are considered for reimbursement under medical benefits. Submit claims using the appropriate medical Current Procedural Terminology (CPT®) Evaluation and Management code. Please note that this policy does not apply when these services are covered under a capitation arrangement.