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Ob-Gyn Coding Alert

Correct Coding Alternatives: Lactation Counseling Need Not Be Free Service

- Published on Fri, Jan 01, 1999
Unlike days past, new mothers frequently are sent home from the hospital well before their milk comes in. While this practice may save money, it likely results in more new moms who have difficulty getting started on breastfeeding their newborns. Lactation consultants are available in the postnatal period to help with the transition, but as ob/gyn coders who have tried to get paid for this service know, there is no CPT code to cover lactation counseling.
But the lack of a CPT code specifically for lactation counseling does not mean that ob/gyns must foot the bill. Here are some suggestions on how to handle collections for this important obstetric service.

Specifically Document Office Visit Codes

First, ob/gyn coders need to understand from their physicians and practice manager how important lactation education is to their practice. In some practices and hospitals, lactation assistance is considered to be a value-added service that attracts patients and keeps them coming back. But it is not considered a revenue center, since reimbursement is low or nonexistent. If this is the case in your ob/gyn practice, then you may wish to bypass collection efforts altogether.

If payment for lactation counseling is important to your office, it may be billed as a skilled nursing office visit, coded simply with the office visit codes (99211-99214), depending on the complexity of the patients presentation. A 99211, for example, is an office visit that does not require the presence of the physician and typically lasts only five minutes. Codes 99212-99214 would require a more detailed history, examination and decision-making, but if more than 50 percent of the face-to-face time was spent in counseling the patient, the E/M code would be selected based on time. Remember, however, that many payers assume that use of these codes (except 99211) means a physician provided the service. You should always check with the payer about billing directly for non-physician services.

To be considered for payment, however, these office visits must meet two requirementsthey must be for a problem, rather than simply for a normal postnatal check, and the lactation counselor must be an RN.

If the patient has mastitis or thrush, then we bill it as a level one skilled nursing visit, explains certified lactation consultant Donna Cordoba, RN, IBCLC, of Austin. The ICD-9 code for Infections of the Breast and Nipple Associated with Childbirth is 675.X. A fifth digit is required. ICD-9 code 676.X is to be used for Other Disorders of the Breast Associated with Childbirth and Other Disorders of Lactation.

Despite the detailed diagnoses options, Cordoba admits that most patients pay out-of-pocket because most insurance companies are extremely stingy, she says. We dont have a lot of luck getting things paid.

Outsource Services and Billing

Ob/gyn practices [...]

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