Primary Care Coding Alert

Question: I am getting denials when I bill V15.82 with 94406. What would be the more appropriate code?

California Subscriber

Answer: Smoking cessation is valid only if there is a proven medical necessity for it which includes people who are diagnosed with a smoking-related illness or are taking medicine that may be affected by tobacco. Using V15.82 (History of tobacco use) will not point out the medical necessity for smoking cessation. Further, ICD-9-CM indicates that V15.82 is considered a secondary diagnosis, so you cannot rely on it as a primary diagnosis in any case.

Therefore, in this scenario, you should specify what specific disease was present in the patient that warranted the program.

For example, a patient enrolled in a smoking cessation program could be reported as follows:

• 491.0 -Simple chronic bronchitis (which includes smokers' cough)

• 305.1 -Tobacco use disorder

• 99406 -Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes.

Code 491.0 is the primary diagnosis as this is the condition the FP is treating. Code 305.1 is the secondary diagnosis as this was the reason for the primary disorder. 99406 is the CPT code. Other conditions associated with tobacco use that will require smoking cessation include cancer, heart diseases and stroke, respiratory problems (for example, bronchitis and COPD), and pregnancy.