Primary Care Coding Alert

Question: What diagnoses does Medicare cover for smoking cessation? For instance, will they pay for 305.1 or V15.82?

Georgia Subscriber

Answer: The patient must have a smoking related condition that is adversely affected by smoking, such as bronchitis (for instance, 491.0, Simple chronic bronchitis, which includes "smokers- cough") or be taking a drug whose metabolism or dosing is affected by tobacco use for Medicare to consider covering 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) and 99407 (... greater than 10 minutes). Eligible conditions include heart disease, cerebrovascular disease (stroke), multiple cancers, lung disease, weak bones, blood clots, and cataracts, according to Medicare's Smoking Cessation Web page (www.medicare.gov/health/smoking.asp). Drugs whose effectiveness is complicated by tobacco use include insulin and some medicines for high blood pressure, blood clots, and depression.

Medicare will not cover smoking cessation counseling for simply stopping using tobacco (305.1, Tobacco use disorder). Code V15.82 is for "personal history of tobacco use," not for a patient who has the disorder.

Don't overlook these additional coverage criteria:

- Medicare will cover up to eight face-to-face visits during a 12-month period.

- A doctor must order the visits and a qualified doctor or other Medicare-recognized practitioner must provide them.