Information for Providers

Patient Education Handouts

• Mastitis
• Engorgement
• Blocked Milk Duct
• Inverted Nipples
• Thrush
• Is Your Baby Getting Enough to Eat?
• Increasing Your Milk Supply
• Re-establishing Your Milk Supply

Position Statements / Policies

The American Academy of Family Physicians

The American Academy of Pediatrics

The American College of Nurse-Midwives

The American College of Obstetricians and Gynecologists

The American Dietetics Association

The Association of Women’s Health, Obstetric, and Neonatal Nurses

The Association of Women’s Health, Obstetric, and Neonatal Nurses - Newborns & Neonates

The National Association of Pediatric Nurses Practitioners

The National Association of Pediatric Nurses Practitioners - NAPNAP Position Statement on Breastfeeding (PDF)

The World Health Organization

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For more detailed information about coding for breastfeeding management, please consult the AAP pamphlet Breastfeeding and Lactation: The Primary Care Pediatrician’s Guide to Getting Paid.

The information below is modified with permission from the AAP Breastfeeding and Lactation: The Pediatrician’s Pocket Guide to Coding.

Commonly used ICD-9-CM Codes Related to Breastfeeding

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BABY	ICD-9-CM Codes
Feeding Problems
Feeding problems or vomiting, newborn	779.3
Feeding problem, infant (>28 days)	783.3
Vomiting, infant (>28 days)	787.03
Jaundice
Breastmilk jaundice	774.39
Neonatal jaundice	774.6
Pretem jaundice	774.2
Weight and Hydration
Dehydration, neonatal	775.5
Weight loss	783.21
Underweight	783.22
Slow weight gain, failure to thrive	783.41
Rapid weight gain	783.1
Infant Distress
Fussy baby	780.91
Excessive crying	780.92
Infantile colic or intestinal distress	789.07
Gastrointestinal Issues
Change in bowel habits	787.99
Abnormal stools	787.7
Diarrhea	787.91
Mouth
Ankyloglossia	750.0
High-arched palate	750.26

Billing for the Infant’s Mother

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The medical provider may bill for the mother if s/he takes the mother’s history, examines the mother’s breasts and nipples, observes a feeding and makes a diagnosis and treatment plan for her.

The mother’s insurance may require a request from her primary health care provider. The mother may be billed as either a new patient visit or a consult (99241-99245) if you have a request and provide a written report back to the requestor.

MOTHER	ICD-9 Code
Breast Issues
Abscess, breast	675.14
Blocked milk duct	675.24
Breast engorgement, ductal	676.24
Burning pains, hyperesthesia	782.0
Ectopic or axillary breast tissue	757.6
Galactocele	676.84
Mastitis, infective	675.14
Mastitis, interstitial	675.24
Other specified nipple, breast anomaly	757.6
Other specified nipple, breast infection	675.84
Nipple
Burning pains, hyperesthesia	782.0
Nipple infection	675.04
Nipple, cracks or fissures	676.14
Nipple, sore	676.34
Retracted nipple, postpartum	676.04
Impetigo (staph), nipple	684
Candidiasis, nipple or breast	112.89
Lactation
Agalactia, failure to lactate	676.44
Lactation, delayed	676.84
Lactation, suppressed	676.54
Other specified disorders of lactation	676.84
Supervision of lactation	V24.1
Other specified follow-up exam (when original reason for visit has resolved)	V67.59

Prenatal Discussion about Breastfeeding

Prenatal breastfeeding education:

• has the biggest effect of any single intervention on improving breastfeeding initiation and duration rates

Medical providers’ attitudes about breastfeeding:

• significantly impacts breastfeeding rates
• if medical providers have a positive attitude and encourage breastfeeding, mothers are much more likely to initiate breastfeeding

How to talk to pregnant mothers about breastfeeding

There are many effective methods to educate mothers prenatally about breastfeeding including structured group and individual classes.

Brief prenatal discussions using the “Best Start” technique also have been shown to increase breastfeeding rates.

• If you are an OB/GYN, you can use the “Best Start” technique during a prenatal visit
• If you are a pediatrician, you can use this interviewing technique during either a prenatal visit with the family or when you notice a mother is pregnant during a sick or well child appointment with one of her other children.

Best Start Technique:

1. Ask:
   • Ask open-ended questions such as “What have you heard about breastfeeding?” instead of “Are you going to breast or formula feed?”
2. Acknowledge:
   • Acknowledge the mother’s specific concern.
   • If she says she heard “breastfeeding hurts” then acknowledge her concern by saying “so, you’re concerned that breastfeeding is going to hurt you.”
3. Advise:
   • Advise the mother specific to her concern.
   • For example, you could tell her that “you may feel discomfort for the first week or two when the baby first starts nursing, but breastfeeding should not be painful. Many women don’t get the help they need after the baby is born, so the baby doesn’t latch-on correctly. If your baby is in the correct position and opens his/her mouth widely, breastfeeding should not hurt. It is important to get help in the hospital from someone knowledgeable about breastfeeding and see your pediatric provider a few days after you leave the hospital”

It would be ideal to also discuss with the family the importance of:

• The baby breastfeeding as soon after birth as possible (preferably in the first hour).
• Avoiding supplementation with formula unless medically indicated.
• Knowing the signs of adequate milk intake.

Your role as a medical provider is crucial in promoting and supporting breastfeeding.

Provider Letter for Employers

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