Pediatric Coding Alert

Question: How can we bill for a lactation consultation that a registered nurse, who is a certified lactation consultant, performs in our office? The nurse usually spends 30-60 minutes with new mothers who need this service.


North Dakota Subscriber
Answer: CPT doesn't include a code for lactation consultation, but you should negotiate with payers to cover this service. For now you have three options:

Code a nurse visit (99211). A physician does not need to provide this office visit service. Although this code may not reimburse well, it is better than nothing.

Involve the pediatrician. If the nurse provides the lactation counseling but the pediatrician participates face-to-face with the patient or family (for example, he approves the way the child is nursing), you may bill a higher E/M level (such as 99212 or 99213).
 
Bill NP services based on time. You may recoup higher-level office visits when a nurse practitioner (NP) provides lactation counseling. NPs can use the full scale of E/M codes (99201-99215), but only if the NP bills under her own provider number, because the NP cannot bill based on time if she is billing "incident-to."
 
Because counseling dominates the visit, you should report the appropriate level of E/M service based on time. For instance, if the NP spends 15 minutes counseling the mother on proper feeding and the importance of breast milk, you should report 99213 (... physicians typically spend 15 minutes face-to-face with the patient and/or family) for the visit.

Whichever way you choose to report the service, use 779.3 (Feeding problems in newborn) as the diagnosis code. Some practices believe so strongly that lactation counseling benefits patients (and mothers) that they provide the service for free -- which is also a good marketing tool for your practice.