Wiki Lactation consultation with office visit

[lmccall2013]

Patient comes in for office visit due to fatigue, insomnia, sore nipples, breast pain and needs a Lactation consultation. Provider does Lactation consultation dx Z39.1. This is done in the office, not in the home so 99501 cannot be used. What CPT would you use for the Lactation consultation? Can we bill an office visit separately from the Lactation Consultation?

Please help!

 

[Cynthia Hughes]

This will depend on the payer's policy for lactation consultations. Some require that services are provided only by International Board Certified Lactation Consultants (IBCLCs). Others consider the lactation consultation incident to the physician's E/M. Separate reporting of a code for lactation consultation and a physician office visit would also be determined based on whether the physician provided a medically necessary, significant and separately identifiable E/M service. I have seen payer policies that require lactation consultants to report with S codes (eg, S9443), 98960, 96150, or even 99401-99404 so it is really important to determine the individual payers reimbursement policy. Not a lot of help, I know, but hope it is some.