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Lactation Nurse

  1. #1
    Default Lactation Nurse
    Medical Coding Books

    Can someone help me? I work for a Pediatrician and came accross a situation where a baby comes in with mother and was seen by the lactation nurse. Can you bill with 99211 with the apporiate dx. Or is there another procedure code I can use to referred to a lactation nurse ?

    Also 99211 is a time base code for 5mins, what if the visit takes longer then 5 mins what code could I use?

    Thanks for your Help!

  2. #2
    Oakbrook, IL
    Question Question about Lactation
    I have a similar situation in the Peds office I work in. We have been billing e/m 99215. I have also heard some offices bill 98960 for education and training. Insurance co's have been paying for 99215 since she does spend up to one hour with the mother and baby in our office. I would also like some feedback on this subject. Thanks.

  3. #3
    Default 98960
    We have an RN in our practice that is trained and has a standardized curriculum that she follows. We code her Lactation consultations using 98960 using one unit for each 30 minutes (usually only 1 unit, occasionally 2 units) You cannot bill an office visit above 99211 unless the child is also seen by the physician. If you are coding a 99215 you are reporting that the physician spent 40 minutes face to face with the patient/family so a 99215 would be inappropriate unless the lactation consultant is an MD, PA or Nurse Practitioner.
    Last edited by bhaskins1; 04-22-2008 at 09:41 AM.

  4. #4
    Bhaskins1, thanks for your help.. So with this said, if there is breast feeding problems that has nothing to due with an illness or a disease. And it is just minor problems that the nurse has to educate the mother. Can you still use this code? and the reason why I'm asking this question because under the CPT guidelines its states illness or disease. Also do you have an article or something that I read to help me to understand a little bit more.

    Again Thanks for your help


  5. #5
    I attended a Seminar and the subject was presented by Joel F. Bradley, MD, FAAP at the North Carolina Pediatric Society Open Forum in April 2007. He presented information about the patient education code and one of the examples he gave was: "Infant and mother visit for breast feeding consultation with your nurse (certified lactation counselor)."

    Also to justify the use of the word illness or disease... feeding problems in a newborn and failure to thrive are both very serious conditions that if left untreated can be life threatening. If you look up the definition of disease in Taber's you will see that this would qualify.

    I hope I have been helpful... sometimes the definitions are subjective but both I and my physicians feel that this would be the correct use of the code. Unfortunately I don't have any documentation that supports this.

    If it is just something minor and the nurse spends 5 minutes or so with the mom then you may want to consider 99211... I would only use the education code if it went further than this.

  6. Default Mom's insurance for Lactation
    We are having this question in our Peds office also. What we are running into is that Mom wants it billed under her instead of baby for insurance reasons (2015 lactation changes). We are making a chart for Mom and documenting the visit along with the baby's chart. The reason for the lactation visit was due to maternal problems. But we did have to examine the baby's mouth and so on. Can we bill the lactation under Mom? Do we have to bill both Mom and baby?
    Last edited by jjurbom; 03-16-2015 at 12:11 PM. Reason: spelling

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