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Subject:
From:
Alla Gordina <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 25 May 2013 11:53:13 -0400
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On 5/24/2013 9:53 AM, Mandy Schaub wrote:
> Are there any OP Lactation Centers that are Hospital based currently charging for Preventative Codes 99401-99404?  We are currently charging using Eval and Management 992.. codes.  I'd like a Preventative option.  Would you be willing to share your pricing strategy?  I can't find anyone in our corporate charge master who uses these codes, so I'm not sure what to charge.  Feel free to email me privately if you wish.

Mandy,
there are several issues here.

1. (first and foremost) The presence on the list (ICD, CPT, whatever)
does not imply neither recognition nor payment from insurance companies.
In the CPT book there are quite a few "feel good" empty codes - like
telephone management for example which are almost never ever paid. We
(health care providers) are supposed to be available for such services
but we are

2. What interventions you are planning to perform and with what
diagnostic codes you will be justifying the 99401-99404 use? and

3. If ( a very big "IF") insurance companies from a goodness of their
hearts (believe me, neither goodness, nor hearts do exist in insurance
companies) will decide to recognize those codes - those are so called
"add-on" codes, meaning that they are used IN ADDITION to the routine
evaluation and management codes. In the IBCLC scope of practice useful
"add-on" codes would be the "prolonged services" and "coordination of
care". But again - nobody would promise that even those will be either
recognized or paid.

4. Regarding the "Eval. and Management 992.. codes". What exactly codes
are you using? As 992** series do include both outpatient visits (9920*
and 9921*) and consultations (9924*).

Alla
Alla Gordina, MD, IBCLC, FAAP

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