Billing Lactation Visit


Cuyahoga Falls, OH
Best answers
WE have a lactation consultant in our OB practice. She recently handed me billing sheet for one of our private patient whom she saw for about and hour. She billed a 99215 for this visit. I want to know if this is correct or if anyone else out their can let me know how the bill for lactation visit's.

Your help would be greatly appreciated.:)
It seems like she may be billing based upon time. Time may be used as the key component for selecting an E/M level if the following conditions are met:

The provider documents total time and suggests tthat counseling or coordinating care dominated more than fifty-percent of the encounter.

Documentation may refer to: prognosis, differential diagnosis, risks, benefits of treatment, instructions, compliance, or risk reduction.

The documentation must indicate: the total time, the content of counseling and/or coordination of care, and that over half of the time was spent counseling and/or coordinating care.

One example is to write something to the effect of, "spent ____ mins of ____ mins counseling (or coordinating) care as documented above".

If all of these conditions are met, then time may be used to select an E/M level. 99215's time condition is 40 minutes, so if her documentation supports it then it should be ok.

Hope that helps.