Ob-Gyn Coding Alert

Question: So I see two postpartum depression ICD-10-CM codes: O90.6 and F53.0. What is the difference between these two codes? Also, how about CPT^® codes: 96127 or 96161? Are they for postpartum depression?

California Subscriber

Answer: Code O90.6 is for “postpartum mood disturbance,” not postpartum depression.

The World Health Organization classifies postpartum depression as one of three things:

• Postpartum blues,
• postpartum non-psychotic depression, and
• postpartum psychotic depression.

Postpartum blues onset within day 3 or 4, can last hours to days, and requires no treatment other than reassurance. This is O90.6.

Postpartum depression can occur any time within 12 months of childbirth, lasts weeks to months, and requires treatment.

Postpartum depression with psychosis usually occurs within two weeks of childbirth, can last weeks to months, and usually requires hospitalization.

There are clinical criteria for postpartum depression (same as for major depression).

As for the CPT^® codes 96127 (Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/ hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument) and 96161 (Administration of caregiver-focused health risk assessment instrument (eg, depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument), you should not use them for a patient being evaluated for postpartum depression.

Neither of these codes would be billable because, per the American Congress of Obstetricians and Gynecologists (ACOG), screening for postpartum depression is integral to postpartum care.

In the case of 96127, the use of any screening tool during the visit would be considered included unless specifically allowed by the payer. For instance, some Medicaid programs pay for additional services, but their policy booklet will tell you this and which code to use. Code 96161 (Administration of caregiver-focused health risk assessment instrument (eg, depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument) represents a caregiver who is filling out the form on behalf of the patient.