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Pulmonology Coding Alert

Advise Smokers to Quit to Score Preventive Points

Published on Wed Jan 28, 2009

It's not as hard as you think to start benefiting from CMS's incentive plan.

Encourage patients to snuff out the nicotine habit and simultaneously be on your way to earning more money in 2009.

Measure 115: CMS's Physician Quality Reporting Initiative (PQRI) has as one of its measures smoking cessation help. To participate in this measure (and earn your bonus), your office must report on the percentage of patients aged 18 years and older who are smokers and who received advice to quit smoking. This measure is to be reported a minimum of once per reporting period for all Medicare patients seen during the reporting period,(whether or not they use tobacco). There is no diagnosis associated with this measure.

Why? Performing interventions to control smoking are strategically important because smoking is the leading preventable cause of death in the U.S. Moreover, clinical interventions are known to be effective in increasing cessation rates. Recommended physician guidelines include: (1) repeated advice and support at all or most visits, and (2) delivery of cessation assistance and followup at all or most visits.

To arrive at the numerator: Include in the numerator patients who received advice to quit smoking. Remember, you must report the correct combination of numerator code(s) on the claim form to properly report this measure. The "correct combination" of codes may require you to submit multiple numerator codes.

Option A: Identify tobacco smokers receiving cessation intervention. (Two G-codes are required on the claim form to submit this category):

• G8455 (Current tobacco smoker) and

• G8402 (Tobacco [smoke] use cessation intervention,counseling).

Option B: If the patient is not eligible for this measure because the patient is a smokeless tobacco user or a nontobacco user, report:

• Smokeless tobacco user: G8456 (Current smokeless tobacco user), or

• Tobacco non-user: G8457 (Tobacco non-user).

Option C: Tobacco smokers not advised to quit, reason not specified. Two G-codes are required:

• G8455 (Current tobacco smoker) and

• G8403 (Tobacco [smoke] use cessation intervention not counseled).

To deduce the denominator: Include all patients aged 18 years and older. A CPT E/M service code is required to identify patients for denominator inclusion; applicablecodes are:

• CPT E/M service codes: 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217,99218, 99219, 99220, 99241, 99242, 99243, 99244, 99245.

Alternative: You can also report 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) or 99407 (...intensive, greater than 10 minutes) with the E/M and the PQRI code for additional reimbursement if the counseling extends beyond three minutes or more than 10 minutes, respectively, notes Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.

When doing so, place modifier 25 on the E/M when reported with 99406 or 99407. This is used for patients who smoke and have complicating factors (i.e., a disease or medication use for which smoking is contraindicated). Report 305.1 (tobacco use disorder) as well as the diagnosis for the patient's chronic condition.

Resources:

• PQRI Overview with left-side navigation menu on CMS's Web site: www.cms.hhs.gov/PQRI/01_Overview.asp

• List of 153 2009 PQRI reporting measures: www.cms.hhs.gov/PQRI/Downloads/2009PQRIMeasuresList.pdf

• 2008 Measure Reporting Specifications (2009 Specs scheduled to print by Dec. 31, 2008): www.cms.hhs.gov/PQRI/Downloads/2008PQRIMeasureSpecs.pdf.

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