Make sure your smoking cessation services are being coded right

June 1st, 2015 - Scott Kraft
Categories:   Claims   Coding   Primary Care|Family Care  
0 Votes - Sign in to vote or comment.

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.


Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.

Latest articles:  (any category)

Things to Consider Before Upgrading Medical Billing Software
August 11th, 2022 - Find-A-Code
Your practice has utilized the same medical billing software for years. The medical billing staff says it is time for a change. You don't necessarily disagree, but you also don't know where to begin your search for new software. There are so many vendors offering so many products that making sense of it all can be challenging.
Calendar Year 2023 Medicare Advantage and Part C & D Payment Policies
August 9th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Each year CMS publishes an Advance Notice of the upcoming years Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies and asks for comments related to it. Each of the comments are carefully reviewed and responded to and often are impactful to changes seen between the Advance Notice and final publication referred to as the Rate Announcement. With health equity as a primary focus for 2023, CMS announced some policy changes that may impact your organization.
How CMS Determines Which Telehealth Services are Risk Adjustable
August 9th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Medicare Advantage Organizations (MAOs) have gone back and forth on whether or not to use data collected from telehealth, virtual Care, and telephone (audio-only) encounters with Medicare beneficiaries for risk adjustment reporting, but the following published documents from CMS cleared that up once and for all by providing an answer to a question specifically related to this question.
OIG Investigates SCAN Health for Risk Adjustment Overpayments With Surprising Results
July 26th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
We’ve seen a number of OIG risk adjustment data validation (RADV) audits recently where the independent review contractor was simply looking for any codes the payer reported that were not supported by the documentation, in an effort to declare an overpayment was made and monies are due to be repaid. However, it was refreshing to read this RADV audit and discover that the independent review contractor actually identified HCCs the payer failed to report that, while still resulting in an overpayment, was able to reduce the overpayment by giving credit for these additional HCCs. What lessons are you learning from reading these RADV audit reports?
Addressing Trauma and Mass Violence
July 21st, 2022 - Amanda Ballif
After events of mass violence, it’s easy to feel helpless, like there is little we can do. In fact, we can help individuals, families, and communities build resilience and connect with others to cope together. The SAMHSA-funded National Child Traumatic Stress Network has developed a range of resources to help children, families, educators, and communities including the following which you can access via links in this article.
The 'Big 2' HIPAA Rules Medical Billing Companies Must Follow
July 20th, 2022 - Find-A-Code Staff
HIPAA covers nearly every aspect of how medical and personal information is collected, utilized, shared, and stored within the healthcare industry. Title II of the rules is applied directly to medical billing companies and independent coders. The 'Big 2' rules that medical billing companies must adhere to revolve around privacy and security.
The Beginning of the End of COVID-19-Related Emergency Blanket Waivers
July 19th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
It appears that the end of the 1135 waivers related to the COVID-19 public health emergency (PHE) has begun. According to CMS, the residents of skilled nursing facilities, long-term care facilities, and inpatient hospice centers have struggled due to the effects of some of the 1135 waivers. CMS is focusing primarily on removing the 1135 blanket waivers that pertain to certain aspects of care, training, and maintenance of these facilities to ensure the weakest of our citizens are guaranteed adequate care.

Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2022 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association