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Subject:
From:
Judy LeVan Fram <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 23 Apr 2013 17:32:27 -0400
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Hello wiser-than-I ones,
 
A mom emailed saying that her insurance company told her on the phone that  
they would reimburse her for my consult if I used the codes 99201-99203. 
Now I  am always undervaluing, using the 75 minute home visit code for a 
visit, whether  90 minutes or 3 1/2 hours (a consult on  this past Saturday, with 
a 5 day  old losing weight, mom with almost no milk, refusing to use 
anything but the  starter SNS the hospital had given her, until husband got 
regular SNS against my  suggestions, which wasn't functioning properly, followed 
by the mom alternating  breaking down, yelling at me, yelling at the husband, 
yelling to her sister,  and the husband then crying. This is in NO way a 
visit of "low  or medium" complexity!".. ) But the 99345 codes are being 
rejected, even with  the severe undervaluing. So, now the insurance company says 
it will reimburse  with the 99203, which is a "30 minute office visit of low 
complexity." My  question is, if this is ethical to use a code that does 
not describe our  consult, so the mom will get reimbursed ( if indeed they do 
in reality.) Now, I  can understand that the "low complexity of medical 
decision making" might  actually be true, since I am not making "medical" 
decisions at all.
 
What are other people thinking and doing in this mess of misunderstanding? 
 
Peace,
Judy
 
 
Judy LeVan  Fram, PT, IBCLC, LLLL
Brooklyn, NY,  USA
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