On 9/22/2013 7:51 PM, vgthorley wrote:
> This is a late response to Dr Alla Gordina's post. I agree that it is 
> inappropriate that the health insurance sector doesn't regard adoptive 
> breastfeeding as part of lactation and it seems the coding depends on 
> definitions that don't fit the whole range of human lactation.

Oh, dear Virginia...
 From your mouth and into the ears of insurances...

Unfortunately we (those practicing in the US) are faced with the grim 
realities of medicine that is driven neither by common sense nor by the 
evidence-based data.
For almost 20 years I am fighting those battles with insurances/coding 
authorities not recognizing the need for simple post-adoption visits 
(considering them the routine wellness visits instead), or the need for 
special care and special diagnostic provisions for children and adults 
affected by prenatal exposure to alcohol (don't start me on that...), 
and now - the adoptive breastfeeding.

Add to the problem that there is a freeze on new diagnostic codes till 
2014-15, as US is bracing itself for implementation of ICD10 (again, 
don't start me on that, G-d help us to survive through ICD10 nightmare) 
while the whole world is preparing for implementation of ICD11.

And while breastfeeding professionals in other countries are able to 
simply add additional diagnoses if ICD10 does not provide some (i.e. 
there is no code to describe adoptive breastfeeding), in the US we are 
faced with denials for services that we are mandated to provide for 
diseases that do have well established diagnostic codes if insurances 
decide to exclude that particular problem from coverage (i.e. primary 
care physicians are routinely not paid for services related to obesity, 
attention deficit/hyperactivity disorder, back pain and so on).

Alla (getting off my soap box :(...)

-- 
Alla Gordina, MD, IBCLC, FAAP
General Pediatrics
Breastfeeding Medicine
Adoption and Foster Care Medicine

Global Pediatrics and Family Medicine
NJ Breastfeeding Medicine Educational Initiative

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