# smoking cessation in the ED



## rlcohen76 (Feb 25, 2011)

Question....Can an ED physician code for Smoking Cessation if the patient presents to the ED with a tobacco related disease (99406/99407) or without (G0436/G0432). This would be in addition to the 9928_ code. 

I am finding very little info on this. I found this http://www.acep.org/pearls/ on the ACEP website.

thank you in advance for your responses!


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## sam_son  (Mar 4, 2011)

I am working for ER. we are using 99406/99407 for smoking cessation. 

Thanks


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## jimbo1231 (Mar 7, 2011)

*Reimbursed?*

Just curious about whether these services are being reimbursed. I know some EDs were using the codes but had backed off. The other issue was meeting the documentation criteria in the EDs etting. Often ED docs will advice aptients to stop smoking but this doesn't meet the documentation criteria for smoking cessation counseling. Do you have specific guidelines for smoking cessation counseling at your ED? Part of it is arranging for follow up. Do you count referral to primary care doc as arranging for follow up. Seems it would be OK if smoking cessation were specifically documented.

Jim


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## rlcohen76 (Mar 8, 2011)

I was wondering the same thing. These are time based codes that require specific diagnosis/documentation and the codes are dependent on whether the patient has a related disease. 
Also...APG's.....there are a certain amount of counseling visits per year that the patients are allowed and I would imagine that not every insurance carrier will reimburse for these.

I am still on the fence as to whether they should be billed seperately or included in the E&M with instructions for the patient to f/u with their pcp or given the name of a dr. 
Aside from a pamplet how much counseling can really take place in such a fast paced enviroment like the ED.


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## sam_son  (Mar 10, 2011)

Yes, these codes are time based codes. And most of the times physician documents that "you have to stop smoking" only. But some times they will document the time spent for counseling to stop smoking and alcohol. 
Even experienced coders missing to code these. Our auditors will found these types of errors some times only because these type of documentation will present rarely.


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## jnewberry (Mar 10, 2011)

The physicians need to document the amount of time spent discussing the cessation as well as what was discussed with the patient. We find that our insurance carriers are paying for this service with documentation being very clear as to what was actually performed.
Hope you find this helpful.


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## Mindy Davis (May 23, 2011)

*Modifiers when billing for Smoking Cessation*

One of our Tenncare providers is not paying on our E&M because of the smoking cessation that we have billed is there a modifier that we should be billing with?


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