Make sure your smoking cessation services are being coded right

June 1st, 2015 - Scott Kraft
Categories:   Claims   Coding   Primary Care|Family Care  

Coding, billing and getting paid for providing smoking cessation services when covered by your payers is almost a no-brainer for any physician practice because, in most cases, cessation services are already being provided to patients who smoke cigarettes.

    Yet practices consistently don’t take advantage of this opportunity and, when they do, don’t follow the instructions for use of the codes, making the service not payable and raising the practice’s audit risk.

    The two smoking cessation codes are 99406 (intermediate smoking cessation counseling, 3-10 minutes) and 99407 (intensive, greater than 10 minutes). Medicare, for example, pays around $15-$16 for 99406 depending on your geographic area, and $29-$30 for 99407. These codes can be billed in addition to any E/M services provided to the patient.

    Different payers cover smoking cessation in different ways. Medicare will allow you to make two cessation attempts per year, with each attempt consisting of up to four intermediate or intensive sessions. In other words, you can bill these codes up to eight times a year per patient.

    Medicare will cover smoking cessation for all smoking beneficiaries, regardless of whether or not the patient has a smoking-related disease or illness. Patients who don’t have any smoking related conditions need not pay a copay or deductible for smoking cessation services. Patients with a smoking-related condition do pay the 20 percent copay and deductible.

    When a patient who smokes is with the physician, the physician should always engage the patient about quitting, and guide the conversation to specific strategies around how to quit in order to bill for this service. Some patients will, of course, decline all attempts at cessation efforts. The physician should nonetheless continue to try to engage the patient around quitting at each visit.

    Here are the two common mistakes made by practices billing smoking cessation counseling services:
  • Failure to document the time. You must document the time specifically spent on smoking cessation counseling to bill either 99406 or 99407. Because the intermediate code requires a minimum of three minutes, you cannot default to the lower level code when the time is absent from the documentation.
  • Failure to document the nature of the smoking cessation services provided. Simply saying you spent a certain number of minutes on smoking cessation is not enough to add a smoking cessation code to your visit. Among the things you can document are any pharmacotherapy offered to patients to help quit, such as prescription medication; discussion of nicotine replacement such as the patch or gum and strategies to quit, including setting a quit date and activities to help mitigate the desire or need for tobacco.

   Remember that you are able to bill an E/M encounter and tobacco cessation counseling on the same date of service, but that the time spend on tobacco counseling is not considered part of the E/M service and should be considered separately.
   Minimal tobacco counseling, such as just advising the patient to quit, would be considered part of the E/M service and not separately billable.


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