Primary Care Coding Alert

Question: We have an inpatient addicted to meth and other drugs. The practitioner documented that he advised the patient to stop using drugs. Should we bill this service with 99406, or is there another appropriate code?

California Subscriber

Answer: No. You would not report 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) for an alcohol and substance abuse screening and intervention. You should only report 99406 for smoking and tobacco-use cessation counseling.

You have a separate set of codes to choose from for alcohol and/or substance abuse:

• 99408 (Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes)
• 99409 (… greater than 30 minutes)

However, to appropriately report 99408 and 99409, the physician must document the specific amount of time he spent with the patient, which you didn’t mention.

According to the CPT^® guidelines, you should report 99408 if the provider spends 15 to 30 minutes screening and performing an intervention with a patient for abuse of alcohol or another non–tobacco substance. You will report 99409 if the provider spends more than 30 minutes screening and performing an intervention with a patient for abuse of alcohol or another non–tobacco substance. As noted in a parenthetical following 99408 in the CPT^® book, do not report services of less than 15 minutes with 99408. Alcohol and/or substance abuse structured screening and brief intervention of less than 15 minutes is not separately reportable.

Don’t miss: For Medicare patients, you may consider reporting G0396 (Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes) or G0397 (… greater than 30 minutes) in place of 99408 or 99409. Codes 99408 and 99409 are non-covered under Medicare, which takes exception to the word “screening” in their descriptors and substitutes the word “assessment” in its corresponding G codes.

Caution: You should never report 99408 in conjunction with 99409. The two codes are mutually exclusive based on the time in the descriptors. Per CPT^®, you should also never report 99408 or 99409 in conjunction with 96160 (Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument) or 96161 (Administration of caregiver-focused health risk assessment instrument (eg, depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument).