Medical Professional Publications

Lactation Consulting in a Pediatric Office

(From the October 2017 Issue of MedStat)

By Dhanu Sant, MD

WholeKids Lactation Team

Dr. Sant received her medical degree from The Ohio State University College of Medicine. She completed her residency in Pediatrics at Nationwide Children’s Hospital and has been on the Medical Staff since 1997. In 2008, she formed WholeKids Pediatrics in Columbus. Here she is seen with her Lactation Consultant Team. Dr. Sant (on the left), Allison (in the middle) and Adrienne (on the right).

Breastfeeding is a critical component of child health and development. A study in Pediatrics in 2010 estimated that if 90 percent of US families complied with the recommendation to breastfeed exclusively for 6 months, the United States would save $13 billion per year and prevent an excess 911 deaths, nearly all of which would be in infants. Astounding statistics!

At WholeKids Pediatrics, we have made a commitment to breastfeeding and improving the success rate of breastfeeding to one year of age. To that end, we began looking at bringing a lactation consultant into the office a few years ago and in 2014 the program was implemented.

We wanted to be able to offer lactation appointments twice a week, ideally about three days apart. This would allow a baby or mother who needed to be seen more frequently to be accommodated.  All newborns of first time mothers are encouraged to schedule a lactation consult at the next available opportunity, within a 7-10 days of the newborn visit. Mothers who are not first time mothers but are having trouble nursing, or want additional support are also offered lactation support if desired. In addition, an experienced mother may encounter trouble with nursing as she returns to work. We provide back to work lactation support as well.

Our lactation consultants are Allyson and Adrienne. Adrienne is a nurse practitioner and has been seeing patients alongside Dr. Sant for six years. She has finished her lactation training and is certified as an ICBLC (Internationally Certified Breastfeeding and Lactation Consultant). Adrienne offers her lactation services to patients on Friday mornings. Allyson is a physical therapist who has led La Leche groups and is also an ICBLC. Her physical therapy background gives Allyson a unique vantage in assessing oral motor skills of young babies.

We brought Allyson on to provide Tuesday morning lactation consults. This schedule gave our patients access to lactation consultation on Tuesday and Friday mornings. Dr. Sant does not see patients on Tuesday mornings, which affords extra exam room space. All lactation appointments are one hour long. Follow-up appointments are made based on the initial assessment and need. There are three appointment slots on Tuesday morning and 1-2 appointments on Fridays. If the Friday appointments are not used for lactation work, these appointment slots are turned into ill visits or are available for newborn visits if needed. The Tuesday schedule seems to be more utilized overall. Logistically, one exam room is set aside to be used for lactation consults. We have a comfortable nursing chair (POANG chair from IKEA) for our mothers in this room. Our nurses triage the patient and weigh the baby prior to the visit, if the lactation consultant desires. Otherwise the lactation consultant will do a weight as part of their own assessment.

Dr. Sant or Adrienne will oversee Allyson’s visits. Chart review is done along with a brief conversation and exam to ensure that provider and baby concerns are being addressed. The charting is completed by one of the providers in the electronic medical record. The visit is always billed as an extended visit using the E&M code of 99215. The current ICD-10 codes that are used for this service/visit, either individually or in combination are:

  • P92.5 Neonatal difficulty feeding at the breast
  • P59.9 Neonatal jaundice, unspecified
  • R63.5 Abnormal weight gain
  • Q38.1 Ankyloglossia

Depending on insurance, this visit may go towards a deductible, require a co-pay, or engender a coinsurance payment. From an expense standpoint for the practice, Allyson is paid an hourly rate, and Adrienne is a salaried employee at WholeKids Pediatrics.  Financially, this has been an added revenue stream for the practice.

We feel that the lactation program has been incredibly successful clinically. We have seen mothers who were not sure about continuing breastfeeding go on to become confident and successful. In addition, babies who were not thriving but had mothers committed to breastfeeding have often turned around and become vigorous nursing infants. This program has been incredibly gratifying for both patients and practitioners. We are glad to have incorporated this service into our practice. 

The opinions and policies expressed in MedStat are those of its contributors, and are not necessarily the opinions or policies of Nationwide Children’s Hospital. Nationwide Children's Hospital does not endorse or recommend any specific opinions, policies, tests, physicians, products, procedures, or other information that may be mentioned in MedStat. The content made available on MedStat, such as text, graphics, images, and other material contained on the website are for general educational and informational purposes only and do not constitute medical advice; the content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Reliance on any content provided by MedStat is solely at your own risk.

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