EM Coding Alert

Question: If our physician performs smoking and tobacco-use cessation counseling, which CPT^® codes can we report?

Nevada Subscriber

Answer: The 2017 CPT^® manual gives you two code choices for smoking and tobacco-use cessation counseling. They are as follows:

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

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 specifically names tobacco use and addiction, substance abuse/misuse, and obesity as types of this behavior.

According to the CPT^® manual, you can report behavior change services like 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 worsen. You can also report behavior change services when the physician performs them to change a patient's harmful behavior that has not yet caused an illness.

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

• 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.
• Because CMS has determined this is a preventive service, the patient would not incur an out-of-pocket expense by way of co-insurance or deductible. However, the modifier 33 should be appended to assure these are not applied.

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