Training may be helpful for all of the staff involved in administering the postpartum depression
screen and needed follow up. Here are scripts that could be used. These are scripts to be used
as a guide by staff and providers to discuss perinatal mental health.
Please review and adapt to the needs of the families in the clinic population.
How to talk about perinatal depression and anxiety with moms:
• How are you feeling about being pregnant/a mother?
• What things are you most happy about?
• What things are you most concerned about?
• Do you have anyone you can talk to that you trust?
• How is your partner doing?
• Are you able to enjoy your baby?
Ask open-ended questions
• “How are you managing to free yourself up to attend therapy appointments?”
• “I’m curious, what seems to be getting in the way of [xyz]?”
Use reflective listening
• “You’re really not sure if your new therapist can be helpful.”
Reinforce action, changes, and strengths
“With all the obstacles that you’ve described, it’s impressive that you’ve been able to make your
therapy appointments. This really speaks to your commitment to yourself and to being the best
mom you can.”
“It was difficult, and you still were able to make it to your visit today. That didn’t just magically
happen, you had to take specific, concrete action to get to where you are right now.”
Normalize concerns
“It is common to feel concerned about how getting help for depression will affect your life.”
“Based on everything you’re going through, it would be odd for you not to feel overwhelmed.”
Summarize the conversation
“So, based on what you’ve described, it sounds like you’re concerned about your depression
because it affects your relationship with your baby and your partner. You also said that you have
to put in a lot of effort to attend therapy appointments and it costs money to get there, which
makes you doubt the process. Do I have that right?”
Ask permission before providing advice/feedback and follow-up
• “Would it be ok if we talk about your depression?”
• “I have some thoughts about strategies to address this, would you be interested in hearing
them?”
• “What’s it like for you hearing this feedback?”
• “What questions do you have for me?”
Avoid saying “I understand”
Say instead, “I can’t imagine what you’re going through” or “that must be very difficult.”
Sometimes patients are looking for simple validation, rather than a solution.
Avoid using the word “but” because it negates what came before it
Avoid saying something like, “You’re working really hard, but you still feel overwhelmed.” Instead,
use the word “and” to acknowledge both truths: “You’re working really hard, and it’s important
to keep focusing on your mental health and self-care. You’ve already made progress by being
here.”
Avoid talking about yourself and your personal challenges or situations
No matter how well-intentioned or seemingly appropriate, patients often perceive this as you
not hearing them.
Response to a positive screen:
“Based on what you’ve told me and your score, I am concerned that you may be having a difficult
time or be depressed. It can be hard to feel this way when you have a baby/young child. There are
things you can do to feel better. Let’s talk about some ideas that might work for you.”
PROVIDER: This is a screen for depression. I’m concerned because you have a high score. Have you been feeling down, depressed, or anxious lately?
PROVIDER: Would you be willing to see someone for help?
PROVIDER: Do you have someone you feel comfortable talking with, such as your clinician, doctor, midwife, or a therapist you already see?
Yes: PROVIDER: Can we help you make an appointment?
No: PROVIDER: Let’s talk about who you would like to talk with. Can we help you identify a provider or connect you to a therapist?
Follow up plan:
If the screen was high:
• A follow up phone call within hours or days after the initial screen was high
• Clinic should decide who will be the staff member who makes this call consistently use this staff member.
• A follow up appointment with the parent’s provider or therapist should take place within a week.
Follow-up call:
PROVIDER: I wanted to follow up with you about the discussion we had when you were in last
week. Have you been able to connect with your provider or therapist?
Yes: PROVIDER: How did everything go?
Things went well: PROVIDER: I am glad to hear that, please let us know if you need any additional information or referrals.
Things did not go well: PROVIDER: Can I help connect you to a different provider?
No: PROVIDER: What has prevented you from connecting with the referral?
Try to problem solve with the parent—if wait time is long provide second referral, if require childcare/ transportation provide additional information.
Response to a high positive screen (20 or more):
“Based on what you’ve told me and your score, I am concerned that you may be depressed. What you
are feeling is real and it is not your fault. It can be very hard to feel this way when you have a baby/
young child. Getting help is the best thing you can do for you and your baby. Many effective support
and treatment options are available. Let’s talk about some ideas that might work for you."
Response to an extremely high positive screen, or anything other than “never” to question 10:
PROVIDER: This is a screen for depression. Based upon your response(s) and/or our discussion, I’m worried about your wellbeing. I believe you need to see someone today. I can help you set something up right now.
PROVIDER: Let’s talk about how this process will go.
Discuss how clinic handles crisis- walk parent through the process, and physically have a staff
member get them to emergency room, OR bring in behavioral health OR find transportation for
them to emergency room.
It’s very important that the clinic has a plan for the child while the parent receives care.
If the place where parent is being transferred does not have child care: ask parent if they have
someone they can call to come and be with them, who can also watch child (mother, sister,
partner). Help parent manage any additional responsibilities (Childcare, eldercare etc.).
If the parent says they do not want to see someone today:
PROVIDER: Is there a reason why you are hesitating?
Listen to parent, try to help parent deal with issues around why they don’t want to see someone. Try NOT to be confrontational, rather gently work with parent to help them feel safe visiting additional resources.
PROVIDER: Can I call someone to be with you? (Such as your mom, partner, sister, friend etc.)
If a parent absolutely refuses to seek further care today, work as hard as you can to have
someone come meet them.
Follow up for High Positive Screen:
Make a follow up call to high positive screens within days or hours. It would be best to have
mother make an appointment for herself within 1 week. If a patient refused further care, call
them within 24 hours and continue trying to follow up call until reached.
PROVIDER: I wanted to follow up with you about the referral you received when you were in last
week. Have you been able to connect with the referral?
Yes: Did everything go alright?
Yes: I am glad to hear that, please let us know if you need any additional information or referrals
No: Would you like a referral to a different provider?
No: What has prevented you from connecting with the referral?
Try to problem solve with the parent—if wait time is long provide second referral, if require
childcare/ transportation provide additional information.
Every clinic should have a Crisis Response Plan prepared. If clinic has no Crisis Resource in place
at time of emergency call 911.
Scripting adapted for the Utah Women and Newborns Quality Collaborative. Original credit to: The Periscope
Project, Lifeline4Moms, and The Kansas Chapter of American Academy of Pediatrics
Screening for depression
If a physician is providing the global obstetrical service (and reporting a global code), the payer may consider screening for depression as part of the global service and not reimburse additionally for the service. This is particularly true if the physician screens every patient for depression as routine. However, some payers may reimburse for this service. Physicians should check with their specific payers.
Treatment for patients with signs and symptoms
If the patient has signs of symptoms of depression (reported with an appropriate diagnosis code), then those services are reported separately from the global service and may potentially be reimbursed.
Diagnosis coding
Mental, behavioral, and neurodevelopmental disorder codes are found in chapter 5, Mental, Behavioral, and Neurodevelopmental Disorders, code block (F01-F99), of ICD-10-CM. Note that many payers will only reimburse a psychiatrist or psychologist for services linked to a diagnosis in the mental disorders chapter.
The possible ICD-10-CM diagnosis codes are as follows:
• F05 Delirium due to known physiological condition
• F30 Manic episode
• F34.1 Dysthymic disorder
• F32.9 Major depressive disorder, single episode, unspecified
Other diagnoses that may be reported may be found in the signs and symptoms and nervous system chapters. Symptoms, Signs and Abnormal Clinical Laboratory Findings, Not Elsewhere
Classified, code block (R00-R99), are found in chapter 18 of ICD-10-CM. Sleep disorders are found in chapter 6, Diseases of the Nervous System, code block (G00-G99), sub code section G40- 47: Episodic and paroxysmal disorders.
Additional Possible ICD-10-CM codes are as follows:
• G47.9 Sleep disorder, unspecified
• R53.81 Other malaise
• R53.83 Other fatigue
• R45 Symptoms and signs involving emotional state
Procedure Coding
The correct evaluation and management code will depend on whether the encounter was for screening or treatment of depression.
If the encounter was for screening for a patient without symptoms, report a preventive medicine code. These codes are selected according to the time spent in face-to-face counseling with the patient. Whether or not these codes will be reimbursed by the payer will vary. Possible procedure codes are:
• 99401-99404 Preventive medicine, individual counseling
• 99411-99412 Preventive medicine, group counseling
If the encounter was for treatment for a patient with a diagnosis of depression or documented symptoms of depression, report an office or other outpatient evaluation and management code. These codes list a typical time in the code descriptions. Time spent face to face counseling the patient must be documented in the medical record. The record must document that either all of the encounter or more than 50% of the total time was spent counseling the patient. Possible procedure codes are:
• 99201-99205 New patient, office or other outpatient visit
• 99211-99215 Established patient, office or other outpatient visit