Psychiatry Coding & Reimbursement Alert

Question: Can smoking cessation codes be used by psychiatrists or should only primary care providers use these codes?  Our psychiatrist is providing smoking cessation to a Medicare patient, and I don’t know if we can report these codes to Medicare.

Texas Subscriber

Answer: When your clinician provides tobacco cessation counseling to an asymptomatic Medicare patient, you use one of the following HCPCS codes depending on the time spent in providing these services:

• G0436 (Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes)
• G0437 (…intensive, greater than 10 minutes)

You should submit the appropriate diagnosis code with these HCPCS codes or else your claim will be rejected. You will have to report V15.82 (Personal history of tobacco use) or 305.1 (Nondependent tobacco use disorder).

According to CMS guidelines on the use of G0436 and G0437 for outpatient and hospitalized Medicare beneficiaries, these services are covered when the counseling is provided by “a qualified physician or other Medicare-recognized practitioner.”Medicare does not limit them to certain specialties. So, as long as your psychiatrist is a Medicare recognized practitioner, you should have no difficulty in obtaining reimbursement for tobacco cessation counseling provided to an asymptomatic Medicare patient using the above HCPCS and diagnosis codes.

When these counseling services are provided to a symptomatic patient, you will need to use other CPT® codes to report these services. Again, like the G codes described above, you will have to use one of the following CPT®codes depending on the time your clinician spent in providing the counseling services:

• 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes)
• 99407 (…intensive, greater than 10 minutes)

Caveat: According to Correct Coding Initiative (CCI) edits, you are not allowed to report 99406/ 99407 with psychiatric diagnostic evaluation codes, 90791-90792. Also, you cannot report these codes with psychotherapy codes, 90832-90838. As per these edits, the smoking cessation counseling codes are bundled into these psychiatry codes with the modifier indicator ‘0,’ which indicates that you cannot unbundle the codes under any circumstances.

For more details on Medicare policy related to counseling to prevent tobacco use, check out section 150 of chapter 18 of the Medicare Claims Processing Manual on the CMS website at http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c18.pdf

For more information on Medicare policy related to codes 99406 and 99407, check out Medicare Learning Network Matters Article MM5878 on the CMS web site at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/mm5878.pdf.