Oncology & Hematology Coding Alert

Question: I heard we're supposed to use G codes instead of CPT codes for tobacco cessation counseling in 2011. Is this true? Mississippi Subscriber

Answer: Yes and no. Codes 99406-99407 (Smoking and tobacco use cessation counseling visit ...) will still be available in 2011 for patients symptomatic of tobacco-related diseases. But Medicare has introduced two new G codes for tobacco cessation counseling for asymptomatic patients, and you should use them for dates of service on or after Jan. 1, 2011:

• G0436 -- Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes
• G0437 -- Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes.

Explanation: Previously, Medicare covered tobacco cessation counseling for patients with diseases related to tobacco use (or signs and symptoms of such a disease). Now, for services on or after Aug. 25, 2010, Medicare covers counseling to prevent tobacco use for patients who (1) use tobacco, (2) are competent and alert at the time of service, and (3) receive counseling from a qualified practitioner. For those patients who aren't symptomatic for a tobacco-related disease, you must include code 305.1 (Nondependent abuse of drugs; tobacco use disorder) or V15.82 (History of tobacco use) on the counseling claim.

Snag: The G codes become effective in January, but coverage began in August.

Solution: For services performed from Aug. 25 to Dec. 31, 2010, Medicare instructs you to use 99199 (Unlisted special service, procedure or report).

Remember: Medicare covers two counseling attempts each year, which means "11 months must pass following the month in which the 1st Medicare covered cessation counseling session was performed," according to MLN Matters article MM7133. CMS allows "two individual tobacco cessation counseling attempts per year. Each attempt may include a maximum of four intermediate [more than 3 minutes up to 10 minutes] OR intensive sessions [more than 10 minutes], with a total benefit covering up to 8 sessions per year per Medicare beneficiary who uses tobacco."

Resource: You will find MLN Matters article MM7133, "Counseling to Prevent Tobacco Use," at www.cms.gov/MLNMattersArticles/downloads/MM7133.pdf.