Coding Question of the Month

MAY 2018: What is the appropriate way to report lactation counseling?

ANSWER:

Routine lactation counseling is considered part of the global obstetrics package for postpartum services and is therefore not reported separately. However, different payers will have varying policies on whether they will reimburse for this service during the postpartum period. It is advisable that you check with your payers for their specific policy and get those instructions in writing.

Antepartum counseling, on the other hand, may be reported and if the counseling is reportable outside the global OB package, you may consider reporting the visits as follows:

  • For a visit in which the patient sees the physician and the lactation counselor, you would report a single Evaluation and Management (E/M) code. The code level selected would be based on the combined level of service by the two providers and supported by adequate documentation.

  • For a visit in which the patient only sees the lactation counselor who is a licensed non-physician practitioner (NPP) such as a PA, NP, etc., reporting E/M code 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional) may be appropriate.

  • If the consultation with the NPP takes considerably longer than the typical time listed for code 99211, reporting CPT code 98960 (Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient) would be appropriate.

  • If a lactation problem has been diagnosed by a physician, to report follow-up services provided by a non-clinical provider, you may consider reporting from code series 96150-96155 (Health and behavior assessment/intervention).

  • If your payer accepts HCPCS codes, you may report code S9443 (Lactation classes, non-physician provider, per session).

  • If a feeding problem exists that requires the physician to spend an additional amount of time addressing the problem, the following codes are appropriate: 99201-99205 (Office or other outpatient visit for the evaluation and management of a new patient) or 99212-99215 (Office or other outpatient visit for the evaluation and management of an established patient). This would include taking the mother’s history, examining her breasts and nipples, observing a feeding, and making a diagnosis and treatment plan for the mom.

For additional breastfeeding resources, please review ACOG’s Breastfeeding Toolkit.

Contact:

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Donna Tyler
Director, Coding
dtyler@acog.org

Joyce Kilgore
Facility Coding Education Specialist
JKilgore@acog.org

Miroslava Rudneva
Coding Education Specialist
MRudneva@acog.org

Tatyana Mallory
Facility Coding Education Specialist
TMallory@acog.org

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