Screening for Postpartum Depression During Texas Health Steps Checkups

Maternal PPD screening can be performed during any Texas Health Steps preventive medical checkup or follow-up visit up to the infant’s first birthday. Providers are eligible to receive separate reimbursement once for conducting maternal PPD screening during an infant’s first year. Additional screenings, if indicated based on a provider’s judgement, are covered by the single reimbursement.

The Texas Health Steps Periodicity Schedule includes seven preventive medical checkups for children from birth through 11 months of age. Those checkups offer a good opportunity to observe mother-child interactions, provide health counseling and offer anticipatory guidance.

“Anticipatory Guidance: A Guide for Providers” promotes age-appropriate anticipatory guidance topics for children, birth through 20 years of age, and mirrors anticipatory guidance topics included on the Texas Health Steps Child Health Clinical Record Forms.

Postpartum Screening at Preventive Checkups

Preventive checkups provide an opportunity to screen mothers who:

• Have not yet had their postpartum checkup
• Missed their postpartum checkup
• Would benefit from repeat PPD screening
• Did not undergo earlier PPD screening for any reason

Reimbursement for PPD screening during a Texas Health Steps preventive medical checkup or follow-up visit does not depend on a mother’s eligibility for Medicaid or her insurance coverage.

Integrating PPD Screening into Texas Health Steps Checkups

Within clinical workflow, determine the best opportunity to conduct PPD screening. An example is to give each postpartum mother a printed or electronic screening tool to complete while she waits for her infant’s visit with the clinician. The postpartum mother must complete the screening tool herself; questions should not be answered by anyone else on her behalf.

Select a validated screening tool from those approved for use by Texas Health Steps providers:

• Edinburgh Postnatal Depression Scale (EPDS)
• Patient Health Questionnaire–9 (PHQ-9)

Score the completed screening tool, using the standards provided for each tool, and assess whether the screen is positive or negative for PPD. A nonclinical staff member may score the screening tool.

The Texas Health Steps provider must review the screening results with the mother, discuss the possibility of depression and clarify the impact it may have on the mother, infant and family.

When a mother screens positive for PPD, she and the Texas Health Steps provider discuss options so the provider can make an appropriate referral.

Approved Validated PPD Screening Tools

• Edinburgh Postnatal Depression Scale (EPDS)

  • A 10-item screening tool available free of charge. A score of 10 or more suggests depressive symptoms. A score of 13 or more indicates a high likelihood of major depression. A score of 1 or more on question 10 is an automatic positive screen because it indicates possible suicidal ideation, and it requires immediate further evaluation.

• Patient Health Questionnaire–9 (PHQ-9)

  • A 9-item screening tool available free of charge in multiple languages. A score of 10 or more indicates a high risk of having or developing depression. A score of 2 or more on question 9 is an automatic positive screen because it indicates possible suicidal ideation, and it requires immediate further evaluation.

Next Steps After a Screening Result

If the PPD screening result is negative:

• Discuss the results with the mother.
• Document the screening results in the infant’s medical record.
• Provide the mother with health education and anticipatory guidance relevant to the infant’s age and development.
• Schedule the infant’s next preventive medical checkup or follow-up visit.

If the PPD screening result is positive:

• Discuss the results with the mother.
• Clarify the ways depression can affect her, her infant and her family.
• Make a referral for additional evaluation or treatment. You may provide a copy of the screening results for the mother to take to referral appointments.
• Refer for emergency evaluation and treatment in the case of suicidal ideation or behavior or signs of postpartum psychosis.
• Provide support resources in the interim until the mother can access services.
• Document the screening results and referral in the medical record.
• Provide the mother with health education and anticipatory guidance relevant to the infant’s age and development.
• Schedule the infant’s next preventive medical checkup or follow-up visit. It may be appropriate to schedule a return visit for the infant sooner than the next scheduled checkup if the mother screens positive for PPD.

Claiming Separate Reimbursement for PPD Screening

Texas Health Steps providers may receive separate reimbursement for PPD screening in addition to reimbursement for an infant’s Texas Health Steps preventive medical checkup or follow-up visit. PPD screening must be performed on the same date of service and filed as an additional line item on the same claim as the infant’s Texas Health Steps preventive medical checkup or follow-up visit. Prior authorization for PPD screening is not required.

Proper documentation and coding must be submitted for the claim to be considered for reimbursement.

Required Documentation

Documentation in the infant’s medical record must include:

• The infant’s name and Medicaid ID number
• The mother’s name
• Date of the PPD screening
• Name of screening tool used
• Results of the screening
  • If the screening result is positive, the referral plan must be noted and the referral documented.

Documentation also should include:

• Health education or anticipatory guidance provided during the appointment
• Schedule for the infant’s next Texas Health Steps checkup or follow-up visit