Gastroenterology Coding Alert

Question: We-re not having much success getting paid for smoking cessation counseling when our physician performs this. What are the guidelines for reporting this service?


Minnesota Subscriber

Answer: You have two codes to choose from when your physician provides smoking cessation counseling. CMS introduced G0375 (Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) and G0376 (Smoking and tobacco-use cessation visit; intensive, greater than 10 minutes) in July 2005.

You should report G0375 for intermediate sessions that range from three to 10 minutes and use G0376 for intensive sessions lasting more than 10 minutes. CMS still includes minimal counseling (less than three minutes) in the E/M code that you report for the patient visit.

Under Medicare regulations, you can report up to two counseling attempts per patient per year. Each attempt can include no more than four sessions (either intermediate or intensive). Medicare Part B covers eight sessions within a 12-month period.

Don't miss: Remember to add an appropriate diagnosis code. The ICD-9 code you report should accurately depict one of two things: either the condition that the patient suffers from that the tobacco use adversely affects, or the condition for which the patient receives a therapeutic agent that tobacco may adversely interact with.

Watch out: You can't use G0375 or G0376 if the primary ICD-9 code is 305.1 (Tobacco use disorder) because that diagnosis alone doesn't medically justify the service. Also keep in mind that these are Medicare rules. Private payers will usually have their own criteria for billing if they cover this service.