FREQUENTLY ASK QUESTIONS
When I'm emailed questions, I will post them here with the answers.
Please check here first before emailing me in case someone has already ask your question.
Most Frequent Questions and Answers
Why do you call the superbill a lactation visit receipt (LVR)?
The first most well known lactation superbill was the UCLA lactation superbill. The word "superbill" is largely misunderstood by many IBCLCs. Many have thought that a lactation superbill is what an insurance company wants to bill the insurance company and that's NOT so. A lactation or any other medical "superbill" is simply a professional receipt of service with the CPT, ICD coding and charges for those services. So, I have name my "superbill" a lactation visit receipt to be more reflective of what it actually is.
Why is an address required in the header of the superbill (LVR)?
If your client submits a copy of the LVR to their insurance company for reimbursement, the insurance company may wish to contact you for more information or if payment is rendered they may wish to send you an Explanation of Benefits to show what they paid or what they possibly denied.
Why do I have to pay for changes to the header of the LVR form and other forms if I have a name, address change or
other change to the forms?
Each LVR is formatted in a Microsoft Word Access program then converted to a PDF and then to a Fillable PDF each time a change is needed this whole process must take place (as well other WORD forms are converted to PDF and then to Fillable PDF forms if you have the Deluxe Packet) . The forms can't simply be edited, they are re-created. It takes time to format and re-create each form. If I'm responsible for mistakes due to a typo, I will not charge for my mistake; however, if you are responsible for not properly filling out the order form and want a change, you will have to pay for the change. As well, if you have a name change to your business or self, an address change, phone change, EIN or NPI, essentially any change, you will be required to pay for those changes. CLICK HERE TO ORDER CHANGES
IF codes change or any significant change in the industry that necessitates a change to the LVR form or this packet, there will likely be an upgrade that could result in re-purchase of the whole packet or just an lesser cost upgrade to prior customers for the LVR form only. It will depend on what changes are made and how significant they are. The ICD-10 LVR Packet is a complete revision of not only codes but the guide booklet to reflect the new coding system and the changes in healthcare with the Afforadable Care Act as well as information on sliding scales, in-network or out-of-network.
Does the use of the LVR give clients a better chance at reimbursement?
That's a hard question to answer since every insurance company offers different plans with different benefits, co-pays and deductibles and these even vary from state to state. I get varying reports from around the United States of some finding it very helpful for their clients to get reimbursement and some not. Unless you are a contracted provider with an insurance company doing the billing direct to the insurance company via electronic billing, it is your professional duty to give your client a professional receipt of services with CPT, ICD and fees charged and paid.
If we have a company (LLC or other incorporated lactation services company) with more than one IBCLC, does each IBCLC need to
have a NPI and EIN, or do we use the company NPI and EIN?
If you are incorporated as a company which plans to hire or sub-contract employee IBCLCs or a partnership of IBCLCs who are incorporated under a business name, then your business should have it's own EIN and NPI separate from each IBCLC whether IBCLC is a partner or a sub-contracted employee or salaried employee. Be sure you understand what I'm saying here. If you have a company incorporated, your client pays the company and the company pays the IBCLCs who provide their services. If you are ordering a LVR for the incorporated business, the header of the LVR should have the company's business name, address, company's EIN and NPI on it. The IBCLCs don't necessarily need to even be listed on the header. Space on the header is limited. A partnership of two might fit with their names. A business with several IBCLCs or where IBCLCs are sometimes changing, doesn't have to have any names of IBCLC providers listed.
NOW, if you are two separate IBCLC with an agreement to cover or working certain days, but you are both independent businesses where the client pay you directly, you both need to have your own LVR using your own business name and your own EIN and NPI.
Do hospital outpatient lactation departments use this superbill (LVR)?
YES, many hospital outpatient lactation departments who are owned by hospital systems around the country use my LVR. The header would not list the IBCLCs as they might change as employees of the hospital system. The name of the outpatient lactation client is used on the first line of the header, the hospital is used on the second, address/city/state/zip are on the third line, client phone number on fourth line and hospital's EIN and NPI on the fifth line.
How do we know when there are changes or updates to the LVR?
You'll know by visiting this website! Anything significant that could impact your use of correct coding will be posted to the website with suggestions for best way for you to incorporate the change. With a significant overhaul such as ICD-9 to ICD-10, it can be expected to have to buy the complete packet. If revisions to this present ICD-10 packet do occur, there will most likely be an upgrade fee only for the LVR (superbill) and instruction guide. At this time, no major changes are anticipated in the near future. (1-1-2014) You may also receive e-mail notification for me of any changes to coding or the superbill that can impact lactation services.
If there are any changes due to the Affordable Care Act, will you update our billing info?
The LVR was revised in August of 2012 to add Preventative Medicine Counseling codes which are also on this new ICD-10 version. It's not expected that any of the CPT or ICD-10 coding will change at any time in the near future. Insurance companies across the nation have their own interpretation or are making decision on how they will met the lactation portion of the ACA. Even from state to state insurance companies are not consistent with what they are doing.
More info on ACA and lactation go to:
(only covers about 20% of mothers; no grandfathered policies, no Medicaid and no self insurance policies)
To keep up-to-date at what is happening around the US, join the following Facebook pages,
What are Place of Service Codes? - Until yesterday (2014.03.06) when I received a call from United Healthcare about a clients claim, I was not aware of a Place of Service Code. I have never run across the need for this code in my research. This code is required on the CMS-1500 when filing an insurance claim in box 24b or filing electronically for insurance reimbursement. Most likely the reason I have never been ask before is because I do only office visits and up until the ACA was using office/outpatient visit CPT codes. Since the ACA I switched to always having the mother be the patient and using the Preventative Medicine Counseling CPT code which are all the same no matter if the service is done in office or home visit.
I'm now recommending that the Place of Service Code be put on lactation visit receipts or superbills to expedite the insurance company having all info they need to reimburse the client. Here are the most likely Place of Service Codes that an IBCLC would use:
Office – 11
Home – 12
Hospital Inpatient – 21
Hospital Outpatient – 22
Birthing Center – 25
I'm just witting across the header of the superbill - Place of Service Code 11 for now till it's time for me to have more printed.
Other Frequent Questions and Answers
Why are there no care paths in the packet?
I feel strongly that there should be no cookie cutter care paths in lactation. Every mother and every baby are uniquely different and make up an truly unique dyad. My personal philosophy on helping mothers, babies and new families is to empower the mother and father with knowledge of lactation and babies. I do a lot of teaching on how to read baby's reflexes and body language and anticipatory guidance. I have lots of handouts I've written to help educate mothers and reinforce my teaching. I don't sell my handouts. I give every mother a set of handouts specific to her situation or unquiness and can print or e-mail her others to customize to her needs.