Pediatric Coding Alert

Question: How can we bill for lactation consultation given in our office by a registered nurse and certified lactation consultant who spends 30-60 minutes with a new mother?

Mississippi Subscriber

Answer: Currently, there is no code for lactation consultation (the AMAs Performance Measures Advisory Group will decide whether to establish a lactation counseling code), and in the future you should negotiate with payers to cover this service. For now you have three options:

Code a nurse visit (99211). A physician does not need to provide this office visit service. Although this code may not reimburse well, it is better than nothing.

Involve the pediatrician. If the nurse provides the lactation counseling but the pediatrician participates approves the way the child is nursing, for example you may bill a higher E/M level (i.e., 99212 or 99213).

Provide nutrition counseling. CPT 2001 includes three new codes for medical nutrition therapy. Although its too early to say whether payers will cover these codes, they could be accessed for lactation counseling.

The codes are 97802 (medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes) for the first-time assessment of a patient on an individual basis, 97803 (medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes) for the reassessment and 97804 (medical nutrition therapy; group [2 or more individuals], each 30 minutes) for group therapy (although its difficult to envision a lactation consultant working with more than one mother-child pair at a time, it could be done). According to CPT, nonphysician practitioners can render these services.

Whichever way you choose to report the service, use 779.3 (feeding problems in newborn) as the diagnosis code.

Some practices believe so strongly that lactation counseling is beneficial to patients (and mothers) that they provide the service for free which is also a good marketing tool for your practice.

Answers for You Be the Coder and Reader Questions contributed by Richard H. Tuck, MD, FAAP, founding chair and member of the AAP coding and reimbursement committee; Thomas Kent, CMM, CPC, president, Kent Medical Management, Dunkirk, Md.; Richard A. Molteni, MD, FAAP, CPT editorial panel member, medical director, Childrens Hospital and Regional Medical Center, Seattle; and, Teri Salus, health policy assistant, division of healthcare practice and finance, AAP.