Pulmonology Coding Alert

Learn to how to capitalize on smoking cessation counseling reimbursement

Confused by the changes in how you can report cessation counseling sessions your pulmonologist provides to Medicare patients? These guidelines will show you exactly how to use new codes G0375 and G0376.

New Codes Mean More Money for Your Practice

The two new G codes represent two types of counseling sessions: Report G0375 (Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) for intermediate sessions that range from three to 10 minutes. Use G0376 (Smoking and tobacco-use cessation visit; intensive, greater than 10 minutes) for intensive sessions, lasting more than 10 minutes. Minimal smoking cessation counseling (less than three minutes) is still included in the E/M code that is reported for the patient visit.

The pay off: Code G0375 has a national reimbursement rate of $12.88, and G0376 has a national reimbursement rate of $25.30. "There is now potential for additional reimbursement for lengthy E/M visits where counseling occurs for smoking cessation," says Denae M. Merrill, CPC, coder for NEM Pulmonary Associates in Saginaw, Mich.

Take note: While G0375 and G0376 were not added to the Medicare system until July of this year, the codes were actually effective on March 22, 2005. Therefore the codes are retroactive to March 22 if the claims were not previously processed under 99199 (Unlisted special service, procedure or report). Physicians were required by Medicare to report 99199 between March 22, when the codes were first introduced, and July 5, when they were actually added to Medicare's system.

Session Length Determines Which Code to Report

Documentation is key when you report the new  G codes. "These are time-based codes, so it is important to keep track of the time that is associated with the counseling service," says Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.

Example: Your pulmonologist treats a 72-year-old patient with chronic obstructive bronchitis and emphysema that he concludes is the result of prolonged smoking. The patient has continued smoking, and the pulmonologist recommends intensive smoking cessation counseling. The doctor documents that he spent 22 minutes with the patient during the first session. You should report G0376 for the session and 491.20 (Obstructive bronchitis and emphysema, without exacerbation) for the patient's diagnosis.

Determine Who Is Covered

 You can report either G0375 or G0376 for counseling given to patients with diseases or poor health linked to tobacco use or with patients taking medications that could be adversely affected by tobacco use. Medicare covers intermediate and intensive sessions for both outpatient and in-hospital patients who meet these qualifications.

Use caution: Medicare specifies that smoking or tobacco-use cessation counseling sessions are not considered reasonable or necessary for inpatient hospital stays associated only with a diagnosis code of 305.1 (Tobacco use disorder).

Therefore, these types of hospital patients will not be covered if tobacco cessation is the primary reason for their hospital stay.

Pay Attention to the Number of Sessions

Under the new Medicare regulations for smoking cessation counseling reimbursement, you can report up to two counseling attempts per patient per year.
 
Each attempt can include no more than four sessions (either intermediate or intensive). Medicare Part B covers eight sessions within a 12-month period.

Add an Appropriate Diagnosis Code

You must also submit an appropriate diagnosis code to properly report the new G codes. The ICD-9 code you report should accurately depict one of two things. It should show either the condition that the patient suffers from that the tobacco use is adversely affecting or the condition for which the patient receives a therapeutic agent that tobacco may adversely interact with.

You Can Still Report an Additional E/M Service

If the pulmonologist performs an E/M service that is above and beyond the smoking cessation counseling session, you can report that additional service.

You should use the appropriate E/M code (99201-99215) and append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). Modifier 25 shows that the E/M service was separately identifiable from the smoking cessation counseling service.