# Diagnosis for Breast Pump



## btadlock1 (Oct 30, 2012)

I have a tricky diagnosis coding issue - part of the problem, is that I have limited info on what the record says...here's what I know:

A mother had a baby prematurely, and something about the baby's premature delivery, is making it impossible for her to be breastfed. Context clues lead me to believe that the problem is more with the baby's inability to feed, than with the mother's ability to produce milk (but I can't be certain on that - I'm still working on getting clarification).

The provider is trying to bill Medicaid for the breast pump, but keeps getting denied for their Dx code, since they were billing a Dx code from Chapter 15 on the maternal record. I was hesistant to offer any alternative codes, because the only ones I found were either unclear, or didn't fit all that well...here are my thoughts:

307.59 - wasn't sure if this can be used on the mother's record, but assuming that the mother is producing milk, and that the baby is just too small to suckle, it seemed like it might qulify as a  "non-organic" problem; my only hangup, is that it's in the mental health chapter, and there's not much guidance on when it's appropriate to use that code, under any circumstances.

I also considered codes like 676.8X and 676.9X, with a secondary Dx of 677 (Late effects, since the problem is a direct consequence of a premature birth).

V24.1 would make a good secondary Dx, but I don't think it's sufficient to show medical necessity for using a breast pump. Any thoughts? I could really use some help, here... Thanks!


----------



## CookieHart (Jul 29, 2015)

*Breast Pump billing DX*

We've had that problem as well, but it's because Medicaid guidelines require just the pregnancy or birth related diagnosis be listed on the order.  Do the funding buckets, if the problem dx is listed, then the pump claim will deny.  They are looking for just the pregnancy diagnosis, nothing with feeding problems, nothing with engorgement, just the pregnancy dx.   So,  normal delivery 650 will work (if the delivery was normal of course)


----------

