Pediatric Coding Alert

Now, there is no CPT code for providing lactation counseling. So, how can pediatricians help mothers succeed at breast-feeding? Its clear that patients want this service and that it is a good marketing idea to provide it. There are various ways that pediatricians can provide the service and get paid.

In a pediatric practice, lactation counseling could be done by a registered nurse (RN), an LPN, or an International Board Certified Lactation Consultant (IBCLC), says Marsha Walker, RN, IBCLC, past president of the International Lactation Consultants Association. Or the physician could be providing the counseling. Regardless of who is providing the service, the big question is: How do you get paid for it? And how do you get paid enough to cover an hours worth of counseling? Some options include:

1. Nurse-only involvement. This is when you would code 99211 (established patient visit, that may not require the presence of a physician). Whether the nurse spends 10 minutes or an hour with the mother and the baby, you could code only 99211. In addition, chances are that during the first few days, the nurse will receive phone calls from a distraught mother before breast-feeding really takes off. Many practices dont feel that they can spare this much nurse time. But for the simple, 10-minute checks which Walker says constitute some breast-feeding counseling cases 99211 is an option. But anything more than a simple check, when things are going well, is at least 30 minutes, she says. And a nurse cant do that, unless you have somebody designated for it. Just bear in mind that you may have to encourage your nurses, who are used to working quickly, to create a stressless and unhurried atmosphere for the mothers.

2. Pediatric nurse practitioners. Pediatric nurse practitioners can use the full scale of evaluation and management (E/M) codes, says Richard H. Tuck, MD, FAAP, founding chairman of the American Academy of Pediatrics (AAP) coding and reimbursement committee. They can code a 99215, if justified, notes Tuck, who practices with PrimeCare Pediatrics in Zanesville, Ohio.

3. Some pediatrician involvement. If a nurse does the counseling, you can only code 99211, says Walker. To code any higher than that, the pediatrician would have to step into the room. And that step into the room is key. The pediatrician can be briefed, and approve the setup, says Walker. That is enough to code a 99212 or higher. As long as there is some physician involvement in the face-to-face time with the mother and patient, you can bill a code other than 99211 (which pays minimally). Note, however, that this cant be just a [...]