Pediatric Coding Alert

Question: At a 13-year-old girl's 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 discusses and recommends a smoking cessation program through the local respiratory clinic or chapter of the American Cancer Society. The physician 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 ... adolescent [age 12 through 17 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.