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 can more accurately document the visit and record the interventions. Consider including these elements:

" The problem or diagnosis related to smoking/ tobacco abuse (such as chronic bronchitis [491.x], emphysema [492.x], asthma [493.x], etc.)

" Any medications/drugs the patient takes that are adversely affected by tobacco use

" An outline detailing the discussion with the patient (including advice regarding how to quit, how to manage side effects, etc.)

" A record of time spent with the patient exclusive to counseling.

Many practices base their smoking cessation counseling template on the Fagerstrom Test for Nicotine Dependence, a six-question test designed to assess the patients nicotine dependency on a scale of 1 (very low) to 10 (very high). Use of a test like this will strengthen your claims for 99406 and 99407.

Find it online at: http://my-healths.blogspot.com/2008/06/fagerstrm-test-for-nicotine-dependence.html.