Ob-Gyn Coding Alert

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 that do not want to hassle with trying to collect for lactation counseling also have the option of bringing in a lactation consultant as an independent contractor, and passing along the collection responsibilities to him or her. In so doing, the lactation expert can be on hand for all the practices ob patients, but can collect payment on her own. For this service, Cordoba charges $50 per hour. She also offers breastfeeding classes to prenatal patients, who pay for the classes out-of-pocket, as they might for childbirth education sessions. A similar arrangement can be made with a local hospital to provide lactation assistance before and after childbirth, and the patient can be billed through the hospital.

Refer the new mom to a free lactation resource, such as Women, Infants and Childrens Clinic or to a local breastfeeding support group, such as the La Leche League.

Finally, Cordoba suggests that ob/gyns hook up with WIC (a state-funded program for low-income families) and get to know La Leche League leaders so that patients can get the support that they need without having to come to the physicians office.

The best advice I can give is for ob/gyns to send their nursing staff to breastfeeding educator programs, Cordoba says. Then they can carve out time for these people to do breastfeeding triage, and help the new moms get the help they need. That way, coders dont have to try to collect for support consultations, and the physicians time is reserved for true medical problems, such as breast infections.