Primary Care Coding Alert

Question: Smoking and tobacco use cessation counseling services require an appropriate diagnosis code, but what if the patient isn’t presenting symptoms of tobacco-related diseases? What diagnosis code do you report?

Arkansas Subscriber

Answer: If a patient comes in for help with smoking cessation, you should report a diagnosis code related to their tobacco use. The Centers for Medicare & Medicaid Services (CMS), whose guidelines are often the foundation for commercial payers’ policies, says, “claims for counseling to prevent tobacco use services shall be submitted with an appropriate diagnosis code” in Section 12.1 of chapter 32 of the Medicare Claims Processing Manual.

You’ll find appropriate diagnosis codes in the ICD-10-CM code set under:

• F17.2- (Nicotine dependence)
• Z87.891 (Personal history of nicotine dependence)
• T65.2- (Toxic effect of tobacco and nicotine)

When selecting a diagnosis code, know that diagnoses should reflect either patient’s dependence on nicotine (F17.2-) or personal history of nicotine dependence (Z87.891), as well as any identified toxic effects of tobacco (T65.2-) that the provider observes and documents.

Each individual payer may have its own diagnosis requirements, so make sure you’re checking the respective policies and following the pertinent guidelines before submitting a claim.

Additional characters required: Pay attention to the coding instructions for F17.2- and T65.2-, as additional characters are required to complete the specific code for your diagnosis. Code subcategory F17.2- requires 5^th and 6^th characters to complete a code, whereas T65.2- requires 5^th, 6^th, and 7^th characters to complete a code.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC