Primary Care Coding Alert

Question: We have been trying to report the new smoking cessation counseling codes, but insurers have denied each claim. A carrier representative said a denials record did not reflect enough counseling to warrant a recent 99406 claim. How can we prevent these denials? Virginia Subscriber Answer: First, be sure that the FP provided enough counseling to justify 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) and 99407 (& intensive, greater than 10 minutes). To qualify for these codes, the physician or other qualified healthcare professional must provide a face-to-face interaction that includes specific validated interventions, which typically involves: " Assessing readiness for change and barriers to change " Advising a change in behavior " Assisting by providing specific suggested actions and motivational counseling " Arranging for services and follow-up. Good idea: Formulate a template for your smoking cessation patients, so you [...]