ED Coding and Reimbursement Alert

Question: We are having a debate in our ED about the new smoking cessation codes. Some think the codes are not for the ED setting, while our coding director insists that we can report them in the ED. Can ED coders report the new smoking cessation codes?

Florida Subscriber

Answer: Yes, you can report the new codes as long as you meet CPT requirements for them. As of Jan. 1, counseling sessions for smokers who want to quit were no longer lumped under the generic counseling and/or risk factor reduction intervention codes (99401-99412, for patients with no symptoms or established illness) or health and behavior assessment/intervention codes (96150-96155, for patients with disease-related problems).

Now, smoking cessation has a pair of CPT codes:

- 99406 -- Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes

- 99407 -- - intensive, greater than 10 minutes.

Historically these services were reported using G codes for Medicare patients only, but the AMA converted G0375 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) to 99406 and G0376 (... intensive, greater than 10 minutes) to 99407. So now, you can report these counseling sessions to all payers.

As the descriptors indicate, the 99406-99407 codes are time-based, meaning you will not have to determine the level of service based on the complexity of the counseling. Also, CPT's introductory language for the counseling risk factor reduction and behavior change intervention codes- section mentions that behavior change services involve specific validated interventions of assessing readiness for change and barriers for change, among other things. Many interpret this statement to require a tool such as the Fagerstrom test for nicotine dependence for smoking cessation readiness.

Example: A pack-a-day smoker with extrinsic asthma with status asthmaticus reports to the ED complaining of wheezing and breathlessness. A nurse practitioner performs a level-four E/M service to address the presenting symptoms, then provides seven minutes of tobacco cessation counseling using the Fagerstrom test.

For this example, you can code for the E/M and the counseling. On the claim, report the following:

- 99284 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: a detailed history; a detailed examination; and medical decision-making of moderate complexity) for the E/M

- 786.07 (Wheezing) linked to 99284 to represent the patient's wheezing

- 786.05 (Shortness of breath) linked to 99284 to represent the patient's breathing trouble

- 493.01 (Extrinsic asthma; with status asthmaticus) linked to 99284 to represent the patient's asthma

- modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) appended to 99284 to show that the E/M and cessation were separate services

- 99406 for the cessation counseling

- V15.82 (History of tobacco use) and 305.1 (Tobacco dependence) linked to 99406 to represent the patient's tobacco use.