According to Barron’s Medical guide Dictionary of Medical Terms, Fifth Edition by Mike A. Rothenberg, M.D., and Charles F. Chapman, depression (ICD-9-CM code 311) is a dejected state of mind with feelings of sadness, discouragement, and hopelessness, often accompanied by reduced activity and ability to function. The condition may be mild and temporary, and is not a risk-adjusted diagnosis.
Major Depressive Disorder (ICD-9-CM code 296.xx) – on the other hand – is generally diagnosed when the patient has a consistent depressed mood or a loss of interest or pleasure in daily activities for at least a two-week period. This mood must represent a change from the person’s normal mood; social, occupational, educational or other important functioning must also be negatively impaired by the change in mood. (Source: National Alliance on Mental Illness, accessed December 8, 2011) Major Depressive Disorder (MDD) is a risk adjusted condition and warrants additional reimbursement under the MRA model.
Diagnosis depression for a patient who really suffers from MDD is inaccurate, as we can see that the two conditions are different. In addition, the financial impact of this error to the capitated provider can be significant. If a 75 year-old, community-dwelling female in Dade County is diagnosed with MDD, the additional capitation is $448.55 PMPM.