Pediatric Coding Alert

Question: At an 11-year-old girls preventive medicine service, a pediatrician learns that the patient has been smoking several cigarettes on a weekly basis for the past several months. The physician explains the ill effects of nicotine to the patient and urges her to stop smoking. The patient shows an interest in changing her behavior. The pediatrician suggests behavioral techniques and schedules a follow-up visit in two weeks. Notes show the pediatrician spent 5 minutes on the smoking cessation counseling. Should I put modifier 25 on 99406 or on 99394?

Florida Subscriber

Answer: In the case you describe, you should append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure or other service) to 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes),according to American Academy of Pediatrics coding experts.

The patient presented for a preventive medicine service (99394, Periodic comprehensive preventive medicine reevaluation and management of an individual & late childhood [age 5 through 11 years]), making this the intended service. To indicate the smoking cessation counseling service is significant and separately identifiable from the preventive medicine service, you append modifier 25 to 99406.

Watch out: Putting 25 on 99406 when reporting a preventive medicine service is not an absolute. To keep the correct usage straight, ask, Which service was the intended service?

Suppose a patient comes in for a scheduled smoking cessation counseling follow-up service. On sign-in, the front desk receptionist notifies the mother that the patient is also due for her preventive medicine service, and offers to work in the well check after the counseling.

Whats the intended service? The smoking cessation counseling would be the intended service. You would append modifier 25 to the preventive medicine service (99391-99385 for new patient preventive medicine service or 99391-99395 for an established patient preventive medicine service) to indicate it is the significant, separately identifiable service.