Catherine:  One of the advantages of being hospital-based is the ability to 
utilize all the different departments.  Meet with your billing people and 
tell them that you want to bill outpatients for lactation services.  This 
is not your responsibility - there is an entire department of people in 
your hospital who get paid by the hospital to bill patients.  You get paid 
(I hope) to provide lactation services to patients.  It took me over a year 
(partly because I have to work thru a corporation as well as my individual 
hospital) to get our billing system in place.  I have a wonderful tech up 
here on the unit (one of her responsibilities is to do all our ordering) 
who has graciously offered to put the billing thru so that the poor mother 
does not have to sit in outpatient admitting with a screaming, hungry baby 
to get put into the system.  Mom calls me, we set up an appointment, she 
comes directly to the unit, I get a copy of her driver's license and 
insurance care, write down the visit Level (we have a 3-tiered system based 
on amount of time spent with mom), write the doctor's order (either verbal 
or standing), and hand the chart to our tech.  She does the billing and 
hands the chart back to me.  Done!  It's about as painless as I could make 
it.  The vast majority of our patients are insured.  I do not bill Medicaid 
patients - the hospital just eats the cost, as there are so few.  As we 
increase our Medicaid population that may have to change, but I'll worry 
about that when the time comes.
I was given approval just last week to bill mothers who have been 
discharged but still have a hospitalized baby for the visit I do with them 
in the SCN.  If the mother, nurse, or doctor requests lactation, that is a 
billable visit. As we revise our nursery standing orders, we will put a 
standing order for lactation on the SCN orders. Our neos do not have any 
problem with writing an order for lactation right now.  A standing order is 
already on the regular nursery and post-partum orders. Our tech pulls the 
baby's face sheet from the chart to get mom's medical record number, and 
puts the billing thru.  The only inconvenient part of the process is that 
the hospital requires a signed consent for healthcare for each visit from 
the mother.
So, work with the experts you have at your fingertips to get this done.  
After all, how many doctors do you know who know how their office/practice 
is actually run?
Speaking of doctors, our unit right now feels like a cardiac unit, as we 
have several mothers with issues (duh, fluid overload, maybe?).  One of 
these moms (premie twins in SCN) is on 3 antihypertensives, an anti-
coagulant, and a diuretic and was told by a cardiologist that she could 
absolutely not pump/nurse because she "is on too many medications"!  She 
was quite upset when I saw her.  I sat with her nurse and looked everyting 
up in Hale (all are OK).  When I spoke with another cardiologist from the 
practice who came to see her yesterday, he told me he told the mom he 
didn't know and would ask me!  I think he was looking for more business as 
he is one of my cardiologists and knew he would cause me to have 
palpitations or a heart block by saying that to a patient.  He is good 
though, in that he actually listens to the patient or the nurse!
Sorry for the length!

Pam Hirsch, BSN,RN,IBCLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL   USA

Feel free to contact me off-list, Catherine, if you want to discuss further.

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