Cardiology Coding Alert

Hint: Learn what to include in 99406 and 99407 documentation.

The leading cause of preventable death is smoking, according to the Centers for Disease Control and Prevention (CDC); however, nearly 7 out of 10 adult smokers in the United States have expressed a desire to completely quit smoking.

When it comes to heart health, research has shown that smoking cessation reduces cardiovascular events, overall mortality, post-myocardial infarction mortality, stroke, aortic disease, and peripheral vascular disease, according to the American College of Cardiology (ACC).

However, despite the benefits of smoking cessation counseling, according to a 2015 CardioSurve survey, just 56 percent of cardiologists said they have a sufficient understanding of current cessation guidelines for counseling, prescribing nicotine replacement therapy or pharmacotherapy, and performing tobacco cessation follow-up.

Let’s look more closely at how you can correctly report smoking and tobacco-use cessation counseling in your practice.

Pinpoint Characteristics of Behavior Change Intervention Services

The 2017 CPT^® manual categorizes the codes for smoking and tobacco-use cessation counseling under “behavior change intervention services,” which are appropriate for people who exhibit behavior that is often considered an illness within itself. The manual names tobacco use and addiction, substance abuse/misuse, and obesity as specific types of this behavior.

Here are the choices the CPT^® manual gives you for reporting smoking and tobacco-use cessation counseling:

• 99406, Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes
• 99407, … intensive, greater than 10 minutes.

According to the CPT^® manual, you can report behavior change services such as 99406 and 99407 when the physician performs the services as part of treating the patient’s condition(s) that the behavior relates to and can possibly exacerbate. You can also report behavior change services when the physician performs them to change a patient’s harmful behavior that has not yet resulted in an illness.

A March 2016 CPT^® Assistant article supplements what the CPT^® manual says about reporting behavior change services.

“Behavior change intervention services involve specific validated interventions of assessing readiness for change and barriers to change; advising a change in behavior; assisting by providing specific suggested actions and motivational counseling; and arranging for services and follow-up,” according to CPT^® Assistant.

Identify CMS and CPT^® Guidelines to Grasp 99406/99407 Requirements

You can report 99406 and 99407 for outpatient and hospitalized Medicare patients who meet all of the following criteria, according to the CMS Medicare Preventive Services Guide:

• Patients who use tobacco; however, they don’t necessarily have to show signs or symptoms of tobacco-related disease.
• Patients must be competent and alert during counseling.
• Patients should receive counseling from a qualified physician or other Medicare-recognized practitioner.

Important: According to the CPT^® manual, you should never report 99407 in conjunction with 99406.

The CMS Preventive Services Guide also lists an extensive list applicable ICD-10-CM codes you should use when reporting smoking and tobacco-use cessation counseling with a note that additional ICD-10-CM codes may apply.

Note: As of Oct. 1, 2016, the copayment/coinsurance as well as the deductible for 99406 and 99407 were waived, so Medicare beneficiaries have a zero-dollar out-of-pocket liability

You can read the Medicare Preventive Services Guide in its entirety here: www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Downloads/MPS-QuickReferenceChart-1TextOnly.pdf.

Remember the Importance of Time when Reporting 99406/99407

The physician should always include the actual time he spent for the smoking and tobacco-use cessation counseling session in minutes, says Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, staff services coordinator/billing/credentialing/auditing/coding at County of Stanislaus Health Services Agency in Modesto, California.

If the session is less than three minutes, the work is already included in the evaluation and management (E/M) service, and you cannot report it separately, Johnson says.

So, when it comes to knowing whether to report 99406 vs. 99407, you should choose the code based on the amount of time the cardiologist devotes to counseling, says Sarah L. Goodman, MBA, CHCAF, COC, CCP, FCS, president and CEO of SLG, Inc. in Raleigh, North Carolina.

As the code descriptors indicate, you would choose 99406 for three to 10 minutes of counseling, and 99407 for more than 10 minutes of counseling.

Although time is a vital component of reporting 99406/99407, Goodman reminds physicians that they must include other specific information in the medical documentation, as well.

“An entry in the patient’s chart simply stating that the doctor spent 12 minutes counseling the patient on tobacco use will not meet the standard for medical necessity nor justify billing the codes,” Goodman says. “Developing a checklist may be helpful to ensure all relevant documentation elements are captured.”

Check out our 99406/99407 checklist to see what other important information the physician should include in the medical documentation for a smoking and tobacco-use cessation counseling session.