Pulmonology Coding Alert

Use G0375 for shorter counseling encounters


When your pulmonologist counsels a patient on smoking cessation, you'll have to answer questions about the patient's insurer and the length of the session before selecting the proper procedure code. Then, you'll need to choose the correct diagnosis codes to ensure the claim's success, experts say.

Benefit: There is finally a way to represent pulmonologists' work when they help patients try to kick the habit. Starting in 2005, Medicare began paying pulmonology offices for smoking cessation sessions. According to Alan Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta, when reporting these encounters to Medicare providers, you should:

• use G0375 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) for sessions lasting 3-10 minutes.

• report G0376 (... intensive, greater than 10 minutes) for sessions lasting more than 10 minutes.

Patients Can Have Up to 8 Sessions Annually

Medicare allows two counseling attempts every 12 months. Each attempt includes up to four intermediate or intensive sessions, for a total of eight possible G0375/G0376 visits in a year, says Denae M. Merrill, CPC, coder for Covenant MSO in Saginaw, Mich. That makes counting the sessions crucial, especially if your pulmonologists counsel a number of patients on smoking cessation.

Consider this example of an initial cessation counseling session, courtesy of Plummer: An established Medicare patient with chronic obstructive bronchitis and gastroesophogeal reflux disease (GERD) is seen in the office. The patient has continued to smoke in spite of previous advice to stop.

The pulmonologist documents the smoking history, including past and present cigarette consumption, number of packs smoked per year, barriers to smoking cessation, etc.  A smoking cessation plan is developed with the patient, and the physician writes prescriptions and refers the patient a local stop-smoking program. Office notes document that the pulmonologist spent 12 minutes counseling the patient.

When reporting this cessation session, you should:

• report G0376 for the counseling
• attach 491.20 (Obstructive chronic bronchitis; without exacerbation) to G0376 to represent the patient's bronchitis
• attach 305.1 (Tobacco use disorder) to G0376 to represent the patient's tobacco dependence
• attach 530.81 (Esophageal reflux) to G0376 to represent the GERD.
 
Note: Medicare accepts these codes, but many private insurers will not. Before filing a smoking cessation claim with G0375 or G0376 to a non-Medicare entity, call the insurer and see if it accepts the G codes. If the insurer does not recognize the G codes, it may tell you to consider the cessation counseling as a part of the overall evaluation and management time.

Check Notes to See if Physician Advised Quitting

The initial counseling session is typically a G0376 because it usually takes more than 10 minutes. During the initial session, the pulmonologist might:

• Ask about tobacco use. "This should be done at every visit for every patient to determine the opportunity to utilize smoking cessation counseling," Merrill says.

• Advise the patient to quit. "When advising patients to quit, doctors should be strong but motivational. They should have materials on hand to give patients about the risk of smoking and the benefits of quitting," Merrill says.

• Assess the willingness to attempt to quit. The patient may not want to try quitting at that time, but the physician could continue to ask questions relating to when he is ready to quit, such as "Would you quit cold turkey or would you like information on nicotine replacement therapy?"

• Assist with the attempt to quit. Merrill says this help might come in the form of further counseling, phone follow-up, nicotine replacement therapy, or handouts to help the patient stay focused on quitting.

• Arrange a follow-up for the patient to come back within a week of the quit date. "Also offer to be available for phone counseling during any other rough stages, Merrill says.

Best bet: If the notes indicate that the pulmonologist performed some of the above counseling tasks, it is likely a G0375 or G0376 service.

Dyspnea, Chest Pain Might Be Counseling Session Diagnoses

When you're diagnosis coding for smoking cessation sessions, focus on smoking-related diseases and conditions, Merrill says. Some appropriate ICD-9 codes for G0375 and G0376 include:

• lung cancers (162.x)
• chronic obstructive lung disease (491.2x)
• asthma (493.xx). 

Other acceptable ICD-9 codes: You can also report smoking-related symptoms such as dyspnea (786.09), cough (786.2) and chest pain (786.50) as diagnosis codes for smoking cessation sessions.