Billing for Smoking Cessation Counseling

Hey guys, I have a list of questions regarding billing for smoking cessation counseling. Sorry for the long thread, but any help would be extremely beneficial.


A. If smoking cessation is provided during a regular E/M visit, can time counseling factor into billing time, in particular I am referring to CPT® codes 99211 through 99215.

**Example 1: if 15 minutes were spent discussing a patients stomach pain and 10 minutes were spent counseling a patient on smoking cessation, could CPT® 9914 be used for 25 minute of face to fact encounter.

**Example 2: alternatively, if 10 minutes was discussing patients stomach pain and 15 minutes was spent counseling for smoking cessation, could CPT® 99214 instead of 99213 be used?

B. Please explain billing based on time. My understanding of billing based on time is that if at least 50% of the face to face encounter is spent counseling or coordinating care, then time can become the largest factor in determining the level of the billing code used. To my knowledge, there is no minimum amount of time that the face-to-face encounter must last before this form of billing can be implemented.

C. If billing for office visit based on complexity, can smoking cessation counseling add to the level of the complexity of this visit? e.g. if a smoking related medication were prescribed or counseling was provided can that increase the overall complexity of a visit. In terms of coding from the 3 key components of medical decision making (problem points, data points, and risk) how does providing smoking cessation factor in?

**If a smoking cessation medication is prescribed that has both generic and prescription forms e.g. the nicotine patch, can that be considered a "moderate risk management option?" This is assuming that a medical prescription is written for nicotine patch.

D. Regardless of office billing code chosen (i.e. CPT® 99213 vs 99214), if smoking cessation counseling is provided, through the use of modifier 25 can CPT® codes for smoking cessation counseling be added on (CPT® 99406 and 99407).

E. If NP or PA provides smoking cessation counseling, is this billed the same way if done by doctor? Is reimbursement the same?