Question 1—Postpartum Depression
Postpartum depression (PPD) is a major depressive disorder that occurs up to one year after birth (Hackley & Kriebs, 2017). Common symptoms of postpartum depression include: anhedonia; sleep disturbance; feelings of loneliness, isolation, or guilt; poor concentration; anxiety; and somatic complaints (Hackley & Kriebs, 2017). Mothers with postpartum depression are also less responsive to their infants and often need help caring for their infant (Hackley & Kriebs, 2017). Studies have shown that postpartum depression can impact child development, behaviors in childhood, and children’s cognitive function (Hackley & Kriebs, 2017).
The Edinburgh Postnatal Depression Scale (EPDS) is the screening tool used at my preceptor’s clinic to assess for postpartum depression. Hackley and Kriebs (2017) state that because postpartum depression has bimodal peaks at 2 and 6 months, the optimal time to screen for postpartum depression is between 2 weeks and 6 months postpartum. The American College of Obstetricians and Gynecologists (ACOG) recommends screening at the patient’s 6-week comprehensive postpartum visit (ACOG, 2018). However, because postpartum depression can occur at any time, studies and the American Academy of Pediatrics (AAP) are now supporting the use of EPDS screenings for mothers at the 2 month, 4 month, and 6 month well child visits (Emerson, Mathews, & Struwe, 2018).
The cutoff score for depression on the EPDS ranges from 9 to 13. The AAP (n.d.) recommends women with a score of 9 or more be further evaluated for depression. A score of more than 12 is considered likely for postpartum depression (Hackley and Kriebs, 2017). Women with these scores should be clinically evaluated, started on treatment, or referred to a a mental health clinician (Hackley and Kriebs, 2017). A score of less than 9 should not rule out depression if clinical suspicion of PPD is present. Any woman indicating suicidal thoughts on the EPDS or during the comprehensive clinical exam should be immediately assessed to determine if hospitalization is needed (Hackely & Kriebs, 2017). For those at high risk, the patient should be taken to the emergency room (Hackley & Kriebs, 2017).
AAP. (n.d.). Edinburgh postnatal depression scale. Retrieved from https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/practicing-safety/Documents/Postnatal%20Depression%20Scale.pdf
ACOG. (2018). Screening for perinatal depression. American College of Obstetricians and Gynecologists, 132(5), 208-212. Retrieved from https://www.acog.org/-/media/Committee-Opinions/Committee-on-Obstetric-Practice/co757.pdf?dmc=1&ts=20190310T2001493232
Emerson, M., Mathews, T., & Struwe, L. (2018). Postpartum depression screening for new mothers at well child visits. American Journal of Maternal/Child Nursing, 43(3), 139-145. doi: 10.1097/NMC.0000000000000426
Hackley, B. K., & Kriebs, J. M. (2017). Primary care of women(2nd ed.). Burlington, MA: Jones & Bartlett Learning.
uestion 2: 6-Week Postpartum Visit
At the 6-week postpartum visit a full physical assessment is done including gynecological exam. Assessment for postpartum depression continues as well as infant bonding and parenthood and transitioning to regular gynecological care (ACOG. Org, 2018). If there were issues with preeclampsia and eclampsia or gestational diabetes these areas are addressed as well. Providing the patient’s primary care provider with the prenatal and post-natal history is recommended as well to help the patient receive care that is complete and collaborative. ACOG (2018) recommends an initial postpartum visit in three weeks which may just include a phone conversation but is not a complete physical exam and then a six week to twelve weeks visit that will include a comprehensive exam. It is recommended that the postpartum visit be no later than 12 weeks postpartum.
ICD-10 codes that are used for these visits are Z39.0 encounter for care and examination of mother immediately after delivery, Z39.1 encounter for care and examination of lactating mother, Z39.2 encounter for routine postpartum follow-up. There are other codes for postpartum encounters but are more disease related. The code that is used most generally is the Z9.2 code (ICD.codes, 2019). CPT codes can be used in the numerical range of 99211 through 99215 to reflect that a postpartum patient is an established patient and is in clinic for a routine exam. The higher the number use the more intensive the visit, or the more information and procedures were provided (supercoder.com, 2018).
ACOG. Com. (2018). Optimizing postpartum care. Retrieved from https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Optimizing-Postpartum-Care (Links to an external site.)Links to an external site.
ICD10.codes. (2019). Code. Retrieved from https://icd.codes/icd10cm/Z712 (Links to an external site.)Links to an external site.
Supercoder.com. (2018). CPT code. Retrieved from https://www.supercoder.com/cpt-codes/99215 (Links to an external site.)Links to an external site.