Oncology & Hematology Coding Alert

Question: May I report 99406 and 99407 in addition to the regular E/M visit that a patient would have on the same day?

South Dakota Subscriber

Answer: Coding experts agree that you should be able to report a separately identifiable E/M alongside coding cessation codes 99406 and 99407 (Smoking and tobacco use cessation counseling visit ...). You should append modifier 25 (Significant, separately identifiable evaluation and management service on the same day of a procedure or other service) to the E/M code.

Rationale: The Medicare Claims Processing Manual, Chapter 32, Section 12.1, says, "Contractors shall allow payment for a medically necessary E/M service on the same day as the smoking and tobacco-use cessation counseling service when it is clinically appropriate."(www.cms.hhs.gov/manuals/downloads/clm104c32.pdf).

The manual then goes on to say you should append modifier 25 to the E/M to show it's separate from G0375 and G0376 (Smoking and tobacco use cessation counseling visit ...), which were the previous codes for the service.Although this paragraph still references the old codes, the descriptors for the old and new codes are the same, and experts assert the guidance should still apply.

Caution: Third party payers may vary on whether you may report smoking cessation in addition to E/M.