Guest guest Posted January 19, 2012 Report Share Posted January 19, 2012 If you are performing the lactation evaluation and assessment and the Dr. is performing for example a well child exam or what have you, the two of you are not duplicating codes. Why would the Dr. perform a lactation evaluation and then send the client to you if they have already developed a diagnosis? They should perform their function....and then send the patient to you for lactation evaluation and assessment. > > Apparently I am pioneering in this field as far as a Medi-cal consultant is concerned. She has told me that there are not specific codes for LC's. I am very new to the insurance/code side of billing for LC services. When I go see a mom in her home, I give her all the info to bill insurance on her own if she wants to. I have never really looked into the codes until I was in the office and was shown what codes the Ped uses. The codes that I have, I thought were designated for LCs. I now know that this is not true. They are the same ones that Peds use in their office. > > The ped said that you can't bill the same code for the same pt on the same day by different people. > > > I am wondering if there are any LC's out there that are working in an office setting, are educating woman on breastfeeding, answering questions and working with moms/babies that are having problems AND are not part of the office staff. > > Thanks for any help. > > Porter BA, IBCLC, RLC > From Heart 2 Tummy > Private Lactation Consultation, Breastfeeding Supplies and Rental Station > @... > > 11444 13th Ave > Hanford, CA 93230 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 19, 2012 Report Share Posted January 19, 2012 my thoughts exactly! Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comwww.facebook.com/thesecond9months.--- Subject: Re: Codes for officeTo: Date: Thursday, January 19, 2012, 10:54 AM If you are performing the lactation evaluation and assessment and the Dr. is performing for example a well child exam or what have you, the two of you are not duplicating codes. Why would the Dr. perform a lactation evaluation and then send the client to you if they have already developed a diagnosis? They should perform their function....and then send the patient to you for lactation evaluation and assessment. > > Apparently I am pioneering in this field as far as a Medi-cal consultant is concerned. She has told me that there are not specific codes for LC's. I am very new to the insurance/code side of billing for LC services. When I go see a mom in her home, I give her all the info to bill insurance on her own if she wants to. I have never really looked into the codes until I was in the office and was shown what codes the Ped uses. The codes that I have, I thought were designated for LCs. I now know that this is not true. They are the same ones that Peds use in their office. > > The ped said that you can't bill the same code for the same pt on the same day by different people. > > > I am wondering if there are any LC's out there that are working in an office setting, are educating woman on breastfeeding, answering questions and working with moms/babies that are having problems AND are not part of the office staff. > > Thanks for any help. > > Porter BA, IBCLC, RLC > From Heart 2 Tummy > Private Lactation Consultation, Breastfeeding Supplies and Rental Station > @... > > 11444 13th Ave > Hanford, CA 93230 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 20, 2012 Report Share Posted January 20, 2012 The codes that are on the sample page in 's ABC book are the same codes that peds use. 2 different people in the same office on the same day can't use the same codes. This is why I was asking what codes people are using. I want to know what other codes people are using. I did come across a code that is used for education that can be used for non-physicians, but of course, so far only 1 insurance company will reimburse it's use. aaaaaanooooying! What is nice is the office staff is now on board and are trying to help me plus they are also doing research. AND word it getting out that I am in her office. We had a new mom/pt that was not happy with her ped and wanted to talk to me. She has several questions....not problems to fix (which was kind of nice). She just needed some education and a reassuring ear. Porter BA, IBCLC, RLC From Heart 2 Tummy Private Lactation Consultation, Breastfeeding Supplies and Rental Station @... 11444 13th Ave Hanford, CA 93230 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 20, 2012 Report Share Posted January 20, 2012 I just shut down my computer so I can't send a link, but isn't there a superbill CD available that has lactation codes? I thought I might have seen it on the ILCA site, but maybe googling it might help. I seem to remember it wasn't expensive, but I just wasn't sure it was worth it for me.Does anyone have it? If you do have you found it useful? Heinz, BA IBCLCBeach Babies Lactation Support, LLC Sender: Date: Fri, 20 Jan 2012 05:05:38 -0000To: < >ReplyTo: Subject: Re: Codes for office The codes that are on the sample page in 's ABC book are the same codes that peds use. 2 different people in the same office on the same day can't use the same codes. This is why I was asking what codes people are using. I want to know what other codes people are using. I did come across a code that is used for education that can be used for non-physicians, but of course, so far only 1 insurance company will reimburse it's use. aaaaaanooooying! What is nice is the office staff is now on board and are trying to help me plus they are also doing research. AND word it getting out that I am in her office. We had a new mom/pt that was not happy with her ped and wanted to talk to me. She has several questions....not problems to fix (which was kind of nice). She just needed some education and a reassuring ear. Porter BA, IBCLC, RLCFrom Heart 2 TummyPrivate Lactation Consultation, Breastfeeding Supplies and Rental Station@...11444 13th AveHanford, CA 93230 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 20, 2012 Report Share Posted January 20, 2012 Pat Lindsey. Her stuff is awesome! She will customize it for you. She's done all the work. Beebe, M.Ed., IBCLC Lactation Consultant/Postpartum Doula www.second9months.comwww.facebook.com/thesecond9months.--- Subject: Re: Re: Codes for officeTo: Date: Thursday, January 19, 2012, 9:13 PM I just shut down my computer so I can't send a link, but isn't there a superbill CD available that has lactation codes? I thought I might have seen it on the ILCA site, but maybe googling it might help. I seem to remember it wasn't expensive, but I just wasn't sure it was worth it for me.Does anyone have it? If you do have you found it useful? Heinz, BA IBCLCBeach Babies Lactation Support, LLC Sender: Date: Fri, 20 Jan 2012 05:05:38 -0000To: < >ReplyTo: Subject: Re: Codes for office The codes that are on the sample page in 's ABC book are the same codes that peds use. 2 different people in the same office on the same day can't use the same codes. This is why I was asking what codes people are using. I want to know what other codes people are using. I did come across a code that is used for education that can be used for non-physicians, but of course, so far only 1 insurance company will reimburse it's use. aaaaaanooooying! What is nice is the office staff is now on board and are trying to help me plus they are also doing research. AND word it getting out that I am in her office. We had a new mom/pt that was not happy with her ped and wanted to talk to me. She has several questions....not problems to fix (which was kind of nice). She just needed some education and a reassuring ear. Porter BA, IBCLC, RLC From Heart 2 Tummy Private Lactation Consultation, Breastfeeding Supplies and Rental Station @... 11444 13th Ave Hanford, CA 93230 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 20, 2012 Report Share Posted January 20, 2012 Pat's website is http://www.patlc.com/ and her email is patibclc@.... Dee Kassing I just shut down my computer so I can't send a link, but isn't there a superbill CD available that has lactation codes? I thought I might have seen it on the ILCA site, but maybe googling it might help. I seem to remember it wasn't expensive, but I just wasn't sure it was worth it for me.Does anyone have it? If you do have you found it useful? Heinz, BA IBCLCBeach Babies Lactation Support, LLC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 23, 2012 Report Share Posted January 23, 2012 Hi , AAAAHHHH the sound of relief as central CA is finally getting much needed rain...but it would last for long I here. Thank you for the info. It is so graciously appreciated. I think she is going to want a cut. I am in her office/practice after all. I admit it. I jumped into this without doing much homework. I really didn't know what it was going to entail. Ped really does have her heart in the right place. She wants to educate moms and a true advocate of breastfeeding. We decided when we started this that we would try a few things for 1 month and see what the insurance company will reimburse. She did say last Friday that she expects that it would be easier if she paid me a flat rate per pt or/and that it may come down to a percentage of time as to who is spending more time with a pt during a given visit. I did reread a section of ABC's of PP p. 233- Which is a great idea, and I talked to the ped about.....1st visit day 3-5 is with me only, unless I see a major problem. She did like the idea. We did not discuss if she would get a cut. I would expect yes, because after all I am in her office. Looking forward to more suggestions, Porter BA, IBCLC, RLC From Heart 2 Tummy Private Lactation Consultation, Breastfeeding Supplies and Rental Station @... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2012 Report Share Posted January 24, 2012 , If you are “employed by” the pediatrician you can see their breastfeeding patients as an “incident – to provider”. This works very well, reimbursement is 100% and can even make money for the practice if they choose to bill separately for mother and baby. They can at least break even if only billing for baby, but most still make money. Your physician’s billing specialist will know what “incident-to” billing is. Attached is the portion of the CMS manual describing incident-to services. These services can be furnished by an IBCLC. From the attached document AAP Coding A. Joint visit physician and allied health professional: (99212–99215) This is a physician visit which is supported and facilitated by the initial work of the allied health professional. The latter begins the visit, records the chief complaint, documents the history, establishes key physical findings, observes and documents the breastfeeding encounter, and counsels the patient about lactation issues related to the problem. The physician can join the allied health provider, baby, and mother partway through the encounter and then: 1. Review the history 2. Examine the infant to confirm and/or add to the physical 3. Document in the chart the physician’s physical findings, diagnoses and plans 4. Write any necessary prescriptions. With the help of the allied health provider, physician time spent on history taking, counseling, and education will be minimized. History, physical, and medical decision-making guidelines will be used to decide the level of the visit code (99212– 99215). Time based coding cannot be used for this visit because the physician will have spent relatively little time face-to-face with the family. Time based coding is based specifically on the physician’s time, NOT the allied health professional’s time. Judy Judith L. Gutowski, BA, IBCLC, RLC 135 McGrath Lane P Box 1 Hannastown, PA 15635-0001 Cell Phone Fax 2 of 2 File(s) aap CODING 3-08.pdf Incident to billing Medicare carriers maual.pdf Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 25, 2012 Report Share Posted January 25, 2012 You'll should look at the state statutes and practice laws definitions. And what services a chiropractor can bill for. I live in a poor community so to meet the needs i wanted to create a non profit community clinic: offering prevention based dental care , prenatal services and lactation services ... The dental is covered as I work under a collaborative agreement with a dentist however according to my state statutes the definition of a community clinic is one being directed by a physician. So I'm thinking if you had a dr that you have a great relationship with You could have the dr write "standing" orders for care,,,, like they do for LPNs and RN's in public health clinics. Fahning RDH, BS, IBCLC Minnesota Baby: Prenatal & Lactation ServicesSent from my iPhone What constitutes a physician? A chiropractor friend and I were thinking about joining forces in her office. She is pediatric certified and I refer to her when I have tongue tie kids or moms with low milk supply. Can she then be the physician? Thanks, Dana Dana Schmidt, BS, RN, IBCLCCradlehold, DirectorBreastfeeding Education & Supportwww.cradlehold.nethttp://breastfeedinghomevisitservices.weebly.com/shop.htmlProviding the minimum amount of intervention for the minimum amount of time for maximum benefit to mother and baby We do not seek to establish any professional relationship with any person or entity as a result of any visit to this Website. Transmission of the information is not intended to create and receipt does not create, a doctor-patient or other professional relationship between you and any medical professional or other individual on this Website. Persons contacting us or any medical professional through this Website should not send personal health, confidential, or sensitive information, and should not ask specific medical questions. The Website is a public forum and any comments that you make or submit to us may be displayed publicly on that forum, so you should be cautious about making such comments. No information submitted electronically through the Website or email to us will be treated as privileged, confidential, sensitive or personal health information unless we have previously entered into a written agreement with you to protect such information. Any person submitting confidential or sensitive information to us without first entering a prior written agreement with us to protect such information waives all rights to confidential protection or doctor-patient privilege. We assume no responsibility for the loss or disclosure of any information that you transmit to us via the Internet. Please call or visit www.cradlehold.net for an evaluation. Please see the attached should you desire more in-depth lactation advice.Home Consultations Breastfeeding Home Visit Services:The best time to observe a mother and baby is when the baby is ready to nurse. We offer flexible scheduling in order to accommodate your baby's needs. A typical initial evaluation lasts approximately 1-1.5 hours. Appointments can be arranged during days, evenings and weekends. http://breastfeedinghomevisitservices.weebly.com/ From: Judith L. Gutowski To: Sent: Tuesday, January 24, 2012 10:04 AM Subject: Re: Codes for office [2 Attachments] , If you are “employed by†the pediatrician you can see their breastfeeding patients as an “incident – to providerâ€. This works very well, reimbursement is 100% and can even make money for the practice if they choose to bill separately for mother and baby. They can at least break even if only billing for baby, but most still make money. Your physician’s billing specialist will know what “incident-to†billing is. Attached is the portion of the CMS manual describing incident-to services. These services can be furnished by an IBCLC. From the attached document AAP Coding A. Joint visit physician and allied health professional: (99212–99215) This is a physician visit which is supported and facilitated by the initial work of the allied health professional. The latter begins the visit, records the chief complaint, documents the history, establishes key physical findings, observes and documents the breastfeeding encounter, and counsels the patient about lactation issues related to the problem. The physician can join the allied health provider, baby, and mother partway through the encounter and then: 1. Review the history 2. Examine the infant to confirm and/or add to the physical 3. Document in the chart the physician’s physical findings, diagnoses and plans 4. Write any necessary prescriptions. With the help of the allied health provider, physician time spent on history taking, counseling, and education will be minimized. History, physical, and medical decision-making guidelines will be used to decide the level of the visit code (99212– 99215). Time based coding cannot be used for this visit because the physician will have spent relatively little time face-to-face with the family. Time based coding is based specifically on the physician’s time, NOT the allied health professional’s time. Judy Judith L. Gutowski, BA, IBCLC, RLC 135 McGrath Lane P Box 1 Hannastown, PA 15635-0001 Cell Phone Fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 25, 2012 Report Share Posted January 25, 2012 (You Not you'll)PS I love this discussion as I'm always looking for alternative ways to proved services....What other ideas have you all had?Sent from my iPhone You'll should look at the state statutes and practice laws definitions. And what services a chiropractor can bill for. I live in a poor community so to meet the needs i wanted to create a non profit community clinic: offering prevention based dental care , prenatal services and lactation services ... The dental is covered as I work under a collaborative agreement with a dentist however according to my state statutes the definition of a community clinic is one being directed by a physician. So I'm thinking if you had a dr that you have a great relationship with You could have the dr write "standing" orders for care,,,, like they do for LPNs and RN's in public health clinics. Fahning RDH, BS, IBCLC Minnesota Baby: Prenatal & Lactation ServicesSent from my iPhone What constitutes a physician? A chiropractor friend and I were thinking about joining forces in her office. She is pediatric certified and I refer to her when I have tongue tie kids or moms with low milk supply. Can she then be the physician? Thanks, Dana Dana Schmidt, BS, RN, IBCLCCradlehold, DirectorBreastfeeding Education & Supportwww.cradlehold.nethttp://breastfeedinghomevisitservices.weebly.com/shop.htmlProviding the minimum amount of intervention for the minimum amount of time for maximum benefit to mother and baby We do not seek to establish any professional relationship with any person or entity as a result of any visit to this Website. Transmission of the information is not intended to create and receipt does not create, a doctor-patient or other professional relationship between you and any medical professional or other individual on this Website. Persons contacting us or any medical professional through this Website should not send personal health, confidential, or sensitive information, and should not ask specific medical questions. The Website is a public forum and any comments that you make or submit to us may be displayed publicly on that forum, so you should be cautious about making such comments. No information submitted electronically through the Website or email to us will be treated as privileged, confidential, sensitive or personal health information unless we have previously entered into a written agreement with you to protect such information. Any person submitting confidential or sensitive information to us without first entering a prior written agreement with us to protect such information waives all rights to confidential protection or doctor-patient privilege. We assume no responsibility for the loss or disclosure of any information that you transmit to us via the Internet. Please call or visit www.cradlehold.net for an evaluation. Please see the attached should you desire more in-depth lactation advice.Home Consultations Breastfeeding Home Visit Services:The best time to observe a mother and baby is when the baby is ready to nurse. We offer flexible scheduling in order to accommodate your baby's needs. A typical initial evaluation lasts approximately 1-1.5 hours. Appointments can be arranged during days, evenings and weekends. http://breastfeedinghomevisitservices.weebly.com/ From: Judith L. Gutowski To: Sent: Tuesday, January 24, 2012 10:04 AM Subject: Re: Codes for office [2 Attachments] , If you are “employed by†the pediatrician you can see their breastfeeding patients as an “incident – to providerâ€. This works very well, reimbursement is 100% and can even make money for the practice if they choose to bill separately for mother and baby. They can at least break even if only billing for baby, but most still make money. Your physician’s billing specialist will know what “incident-to†billing is. Attached is the portion of the CMS manual describing incident-to services. These services can be furnished by an IBCLC. From the attached document AAP Coding A. Joint visit physician and allied health professional: (99212–99215) This is a physician visit which is supported and facilitated by the initial work of the allied health professional. The latter begins the visit, records the chief complaint, documents the history, establishes key physical findings, observes and documents the breastfeeding encounter, and counsels the patient about lactation issues related to the problem. The physician can join the allied health provider, baby, and mother partway through the encounter and then: 1. Review the history 2. Examine the infant to confirm and/or add to the physical 3. Document in the chart the physician’s physical findings, diagnoses and plans 4. Write any necessary prescriptions. With the help of the allied health provider, physician time spent on history taking, counseling, and education will be minimized. History, physical, and medical decision-making guidelines will be used to decide the level of the visit code (99212– 99215). Time based coding cannot be used for this visit because the physician will have spent relatively little time face-to-face with the family. Time based coding is based specifically on the physician’s time, NOT the allied health professional’s time. Judy Judith L. Gutowski, BA, IBCLC, RLC 135 McGrath Lane P Box 1 Hannastown, PA 15635-0001 Cell Phone Fax Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 25, 2012 Report Share Posted January 25, 2012 So I have two questions: 1. Pediatricians can bill for seeing mothers? 2. How do you find out if your state/local Medicaid program will reimburse for these ICD-9 codes? My children's pediatrician is considering hiring me part time but I can't convince him to do so unless I can show that he'll get paid. A good portion of his patients are Medicaid. Thanks! Benz, MA, CLC, LCCE, IBCLC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 26, 2012 Report Share Posted January 26, 2012 Judy, oooohhh Thank you so much for the info. I remember seeing this somewhere, but don't know where and obviously did not understand/digest the info to my advantage. Thank you again, Porter BA, IBCLC, RLC From Heart 2 Tummy Private Lactation Consultation, Breastfeeding Supplies and Rental Station @... Quote Link to comment Share on other sites More sharing options...
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