Wiki Billing For A Pedatrician Counseling For Breast Feeding Mothers

[jujureeves66]

I am in need of some assistance/guidance. I have a Pediatrician, that during a Well Child Visit for Newborns, gives extensive counseling to the new mothers on breast feeding and lactation. She wants me to bill insurance for this. I have been submitting the claims with 99401 and Z78.91 and sending the claims on paper with a copy of the doctor's notes. I am billing this on the child's claim along with 99391. I am putting modifier 25 on 99401. The EOB's are coming back showing that 99401 is a bundled service with 99391. She insists that other pediatrician's are being paid by insurance by billing it this way. I keep telling her that we need to bill this under the mother's insurance on a separate claim for the counseling portion only. Is my thinking correct? Has anyone encountered this? Please help.

Thank you.

 

[kookykk]

Did you have a Mod 25 on the 99391 as well? You may need them on both if you are billing other services. I work in Ped's but we don't bill for that in our office. Sorry I can't be more help.

 

[jujureeves66]

I have tried mod 25 on both the em code and counseling code with both are used. I have tried 25 on the em code only, or on the counseling code only. I have sent copies of the provider notes with the claims showing where she did the counseling with the new mother's. I'm at a loss. When I call the insurance companies they are not help at all (I know they are not suppose to be, but it would be nice if one would just point me in the right direction).

Thank you for your reply. I appreciate it.

 

[kkocherer]

it is my understanding that since peds department cannot bill for an adult, an office visit code is billed with 25 modifier for feeding concerns in newborn. Our coding director gave me a pamphlet from National Breastfeeding Center (www.NBfCenter.com) which explains how to bill for it.