Medicare offers several preventive services to beneficiaries but are these services being offered to Medicare patients? The annual depression screening is often an overlooked service which would be beneficial to the patient as well as the practice.
Out of all age groups, older adults have the highest risk of suicide. One in six people over the age of 65 suffers from depression. An estimated 25% of those with other illnesses such as cancer, arthritis, stroke, chronic lung disease, and cardiovascular disease have depression. The depression screening is so important in the primary care setting because 50-75% of these older adults who commit suicide saw their primary care doctor during the prior month for general care and 39% saw their primary doctor during the week prior to their death.
Illness, as mentioned above, and other stressful events, like losing friends and loved ones, are major risk factors for depression. Mental illness is under-recognized and under-treated in primary care settings which causes missed opportunities to improve health. Major depression symptoms that are felt nearly everyday include, but are not limited to, feeling empty or sad; less interest in daily activities; weight loss or gain without dieting; less ability to think or concentrate; tearfulness, feeling of worthlessness, and thoughts of death or suicide.
The Centers for Medicare and Medicaid Services (CMS) has stated it will cover a depression screening (up to 15 minutes) annually for Medicare beneficiaries when performed in a primary care setting with staff-assisted depression care supports. The staff-assisted depression care supports consists of, at minimum, clinical staff (e.g., nurse, physician assistant) who could notify the physician of the screening results to help assure accurate diagnosis, can handle referrals to mental health treatment when needed and follow-up as needed.
There are several screening tools for depression screening and CMS does not identify any specific screening tool but rather leaves the choice of screening tool at the discretion of the clinician. Here is an example of a screening worksheet that could be used. This can be filled out by the patient while waiting for their appointment or these questions could be verbally asked to the patient with their answers documented in their clinical note.
This service is covered once in a 12-month period where the Medicare Part B coinsurance and deductible are waived. This does not include treatment options, therapeutic interventions such as pharmacology, combination therapy, or other interventions for depression. Providers would bill G0444 for this depression screening and should re-evaluate their patients at least yearly.
Sources: CMS.gov
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