May 2021

Help Screen for Clinical Depression

Although many patients may show up at their provider’s office with physical symptoms consistent with depression such as pain, poor sleep or poor appetite, the diagnosis of depression may go unrecognized. Providers may not have the tools, or the time needed to screen or treat such patients. Blue Cross and Blue Shield of Illinois (BCBSIL) understands these challenges and wants to help.

Did you know?

Major Depressive Disorder (MDD) remains a treatable cause of pain, suffering, disability and death¹
Many depressed patients go to their primary care physicians (PCP) instead of psychiatrists, and several studies have found that PCPs underdiagnose and undertreat depression²
Although PCPs are able to accurately diagnose depression when symptoms are recognized, data suggest that depression goes undetected about half the time it’s present, with some estimates of recognition as low as 36.4%³

Who should be screened?

All members who are 18 years of age and older without a current diagnosis of depression, bipolar disorder or other mood symptoms from a qualified physician or behavioral health clinician

Who shouldn’t be screened?

Patients who have had an annual depression screening or refuse to participate
Patients who are in an urgent or emergent situation where a delay in treatment may jeopardize the patient’s health status
Patients whose functional capacity or motivation to improve may impact the accuracy of results (e.g., certain court-appointed cases or cases of delirium)
Patients who currently have a confirmed depression or bipolar disorder diagnosis from a qualified physician or behavioral health clinician

Screening Tool and Tips

Ask patients to complete a depression screener in your office, such as the nine-question patient health questionnaire (PHQ-9) available in multiple languages.
Report results for informational purposes only (not reimbursement) using procedure code G8431 (positive screen with plan) or G8510 (negative screen) from the Centers for Medicare & Medicaid Services Adult Core Set in conjunction with standard outpatient procedure code(s) for the visit.
If there’s a positive screen, include one or more of these next steps in the follow-up plan:

Additional evaluation for depression
Suicide risk assessment
Referral to a practitioner qualified to diagnose and treat depression
Pharmacological interventions
Other interventions or follow-up for the diagnosis or treatment of depression

Questions? Contact the BCBSIL Behavioral Health Quality Improvement team.

¹NIH, National Library of Medicine, Is this patient clinically depressed? March 2002. https://pubmed.ncbi.nlm.nih.gov/11879114/

²NIH, National Library of Medicine, The Role of Algorithms in the Detection and Treatment of Depression in Primary Care, 2003. https://pubmed.ncbi.nlm.nih.gov/12625795/

³Psychiatry Services, National Rates and Patterns of Depression Screening in Primary Care: Results From 2012 and 2013, July 2017. https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201600096

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to third party sources or organizations are not a representation, warranty or endorsement of such organizations. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.