As you know, it is a real concern on how to get adequately and properly
reimbursed for lactation counseling.  It is a problem for pediatric practices
too since we usually provide such services for free.  I was pleasantly
surprised to see an article in the Dec. '98 issue of Pediatric Coding Alert
talking about strategies for billing lactation counseling.  It was a very
positive article about breastfeeding.  Some of the suggestions included
billing an office visit under the physician's name (the first lactation
counseling visit with a clinical nurse specialist who is a certified lactation
consultant is done when the baby is 3-5 days old ), paying attention to proper
ICD-9 codes (783.3 - feeding difficulties and mismanagement) and/or refer to
the lactation specialist at the hospital.  I know my pediatric practice does
lactation counseling without charging for it.  As you know, these sessions
with new moms can and do take time - not something you can rush.
Reimbursement is an issue for all of us.
Andrew MD FAAP
General practice pediatrician
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