Can anyone provide guidance on how to bill for lactation services provided by an IBCLC who is an employee of a pediatric office? What codes are used to bill for these services? Are the services billed under the newborn or mom?
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We typically schedule lactation visits separate from the baby’s well check and bill under the mother only. The exception would be identifying a feeding problem during the baby’s well check. In that case, if the mother’s history is taken, an exam of the breast and nipples is performed, the lactation consultant observes a feeding, diagnoses the patient, and develops a plan of care, the mother should be seen as a second patient. In other words, two patients, two visits, two records, and two bills. We bill based on time for the lactation visits. The diagnosis is Z39.1: Encounter for care and examination of lactating mother.
Hope this is helpful!
Lorri,
Thank you for that information. Do you mind me asking if your IBCLC is a nurse (and not an MD/PA, etc)? Is she credentialed or do you bill as “incident to”? And, lastly, are you getting reimbursed?
Thanks
Are you billing the mother’s visit in the office, the same time as the baby’s exam? Are you getting reimbursed?
Yes - we see both mom and baby, bill separately. Yes, we get reimbursed. We rarely do a lactation visit at the same time as a well-check. That scenario has been a little messy.
So you are billing an E/M on mom, as a new patient? Visit just for her and if visit with baby exam? What are the “messy” details?
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If we try to “add” the lactation visit to the 99391, the 99213 (with the diagnosis of feeding difficulties and mismanagement) will get denied even with a modifier. So, I would suggest not trying to double-dip on the baby at that visit. We usually have the mom come back with the baby the next day (tell her we need more time), then bill a level 4 or 5 for mom (based on time) and see the baby for the 99213/4 for the R63.3.
One of our nurse practitioners is a lactation consultant - so then it’s easy. When our nurse sees them (also and IBCLC), our nurse sees the mom and baby first, documents the CC, etc. The provider then joins the visit, examines the baby and reviews the history, adds to the ROS and exam, enters the diagnosis and plan, and writes any Rxs. We can bill based on time, usually a level 3 for both mom and baby. But, if the nurse spends more time, then we just need to add more to the MDM to code higher.
Lori,
Does your nurse practitioner also see the mom as well (review history, ROS, etc) in order to bill for her?
Yes, if our NP sees the mom, it’s way easier. She then bills based on time (level 4 or 5) and bills for the baby too. We have never had a problem getting reimbursed. She does a full note including an exam of breasts/nipples, makes a diagnosis, and plan. It’s a great service our families love.
Thank you for the detailed info. Could you also kindly share the CPT codes for time based billing for moms and if Medicare pays …as Pediatricians we are not credentialed with Medicare.
Hello, We have two certified lactation consultants at our practice that have been providing lactation counseling for many years but only billing for the newborn, not mother. They recently approached me and the partners of the practice with a request to treat, chart, and bill for the mother as well. When presenting to the group, many had valid questions/concerns surrounding pediatricians /adult patients/ insurance contracts/labs.
If you are willing (Lorri or anyone else providing these services) to speak with me regarding how you handled certain aspects, I would really appreciate it.
Thank you!