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Lactation services in pediatric office

E

ebentley05

Contributor
Messages
10
Location
Lehigh Acres, FL
Good afternoon,
We have a provider who is certified Lactation consultant. How would we bill for these services if we are pediatric office and Mom is not our patient?
 
HiEBentley, :) 🍼

You can have billing of CPT 99241-99425 consult care as outpt. in office. Ensure document properly of date when treatment starts, doc name referred on claim, and proper dx codes. CPT 96150,or 96040 CPT 98960, 99502 home visit if newborn still 97530 97535 work breast pump patient's mother caretaker education as a QHP Lactation Consultant. Also can do CPT 99211(can be used for QHP too). Ensure the Lac consult give good notations /describe problem Mom and baby having and assign dx code. I d have the referring doc be the peds doctor in the office since recommending this help and list their name on claim. Dx codes can range from 091.23 , N61, I80 or with dx Z39.1 per notations. Also if baby having eating difficulties add dx code of R63.,3 or F50, or P92 if newborn status
Well I hope helped you.🚼
Lady T
 
Last edited:
Can someone point me in the right direction to find the billing and coding guidelines for lactation consult? I'm in SC and the peds office that I bill for is considering offering this service. Thanks for your help.
 
rhodesv98 said:
Can someone point me in the right direction to find the billing and coding guidelines for lactation consult? I'm in SC and the peds office that I bill for is considering offering this service. Thanks for your help.
Click to expand...
It looks like Lactation consults can be billed as consults or as a regular E/M (depending on payer and if consult requirements are met).
Here is a nifty document I found, put out by the AAP (American Academy of Pediatrics):

AAP Breastfeeding Coding Pamphlet

Here is another article, though I don't know anything about the source:

CPT Codes for Lactaion Consultation Services
 
Hi all,
We are also looking into adding this to our practice. Does a pediatric office with an LC need to update the credentialing contracts with payers to bill the services for mom with the pediatrician registered as an LC?
Thank you for any advice, as we're a small practice.
 
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