# Smoking Cessation Documentation



## suemt (Mar 22, 2017)

Looking for feedback from other auditors.  Is there any formal criteria or guidelines for documenting smoking cessation?  Obviously "counseled patient not to smoke" wouldn't support 99406, but how much more information is needed than "counseled patient not to smoke for 5 minutes"?

Looking for something authoritative, even if just guidelines from a particular payor.  

Thank you!


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## thomas7331 (Mar 23, 2017)

I don't know of any documentation guidelines, but a good resource I've used and shared with providers is section 210.4 of the Medicare coverage determination which you can find here:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/ncd103c1_part4.pdf

A couple of important points to note are:  _'minimal counseling is already covered at each evaluation and management (E&M) visit_' so, as you've noted, it's not sufficient to just say the provider counseled the patient not to smoke; and, that if you read through the guidelines it is apparent that this counseling is intended as a service to help a patient quit - not to tell them they should quit.  In other words, this shouldn't be billed for time spent trying to convince a patient to stop smoking, but rather for the time spent counseling the patient on techniques and resources they can use to quit.  So based on the this information, I advise my providers that they should document the medical issues that are affected by the smoking, that the patient is making an attempt to quit, the kind of counseling that was given to support the attempt, and of course, the amount of time spent.  Hope this helps some!


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## suemt (Mar 23, 2017)

thomas7331 said:


> I don't know of any documentation guidelines, but a good resource I've used and shared with providers is section 210.4 of the Medicare coverage determination which you can find here:
> 
> https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/ncd103c1_part4.pdf
> 
> A couple of important points to note are:  _'minimal counseling is already covered at each evaluation and management (E&M) visit_' so, as you've noted, it's not sufficient to just say the provider counseled the patient not to smoke; and, that if you read through the guidelines it is apparent that this counseling is intended as a service to help a patient quit - not to tell them they should quit.  In other words, this shouldn't be billed for time spent trying to convince a patient to stop smoking, but rather for the time spent counseling the patient on techniques and resources they can use to quit.  So based on the this information, I advise my providers that they should document the medical issues that are affected by the smoking, that the patient is making an attempt to quit, the kind of counseling that was given to support the attempt, and of course, the amount of time spent.  Hope this helps some!



Thanks, Thomas.  I had this as one of my resources, but it's from 2005 - at a time when they differentiated between counseling for patients with specific smoking related conditions (such as asthma) vs. patients who smoked but didn't have any current smoking related problems and I haven't found much more recent.  

But I really like your pointer about differentiating between convincing them to stop vs. having a discussion with them on what specifics might work for that patient.


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## thomas7331 (Mar 23, 2017)

Actually this has been updated since 2005 - if you scroll down to section 210.41 you'll find the information about the counseling as a preventive service that was added more recently, and you will also find this in the Medicare publications about covered preventive services.  But I don't think it affects how providers would document and bill the service because the code definitions haven't changed - they've just expanded the coverage to include it as a preventive benefit.


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