PDPM Coding Question – Recently, we’ve had several new admissions who have a diagnosis of major depression. Just by talking with some residents in my rounds, I would think depression would be captured on the MDS assessment. I’m told that we almost never capture depression, but our residents seem depressed. What are we missing?

Recently, we’ve had several new admissions who have a diagnosis of major depression. Just by talking with some residents in my rounds, I would think depression would be captured on the MDS assessment. I’m told that we almost never capture depression, but our residents seem depressed. What are we missing?

A:

On average, indicators of moderate to severe depression (total severity score = ≥10) identified through the Resident Mood Interview (PHQ-9©) will increase your daily PDPM reimbursement by approximately $38.00 per PPS day. Depression end-splits also reflect increased CMI for Medicaid rates. The greater reimbursement accounts for the service delivery these patients require. Typically, providers have opportunity to reinforce interview techniques. Staff who are conducting interviews should follow guidance in Appendix D of the RAI, Interviewing to Increase Resident Voice. This guidance should be reviewed routinely, along with Steps for Assessment for conducting the PHQ-9. First and foremost, the interviewer must approach this process with meaningful intent, knowing the outcome of the interview will assist in establishing an individualized care plan. Keep in mind, the look-back period for this item is 14 days, which will most likely include a qualifying hospital stay for the Part A residents. Long-term residents may also be triggering depression indicators related to ongoing social distancing or lack of visitation.