Pulmonology Coding Alert

Reserve codes 99406-99407 for symptomatic counseling claims.

When an asymptomatic Medicare patient who uses tobacco presents to your office, make sure you're reporting expanded smoking and tobacco-use cessation counseling codes -- G0436 and G0437 -- to ethically recoup documented counseling time.

Check out some tips on what you need to know to code and bill for these services:

Don't Miss Cessation Counseling Waiver

If you think you should use G codes to replace the usual CPT® codes for tobacco cessation counseling, you are correct -- although not entirely. You can still call on codes 99406-99407 (Smoking and tobacco use cessation counseling visit ...) for counseling provided to patients who use tobacco and have a condition that is adversely affected by tobacco use and/or are undergoing a treatment that is adversely affected by tobacco use. However, Medicare has introduced two new G codes for tobacco cessation counseling for asymptomatic patients who have not been diagnosed with a tobacco-related disease, and you should use them for dates of service on or after Jan. 1, 2011:

• G0436 -- Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes
• G0437 -- Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 10 minutes.

According to the MLN Matters article #MM7133 "Counseling to Prevent Tobacco Use" (https://www.cms.gov/MLNMattersArticles/downloads/MM7133.pdf), "CMS has created two new G codes for billing for tobacco cessation counseling services to prevent tobacco use for dates of service on or after January 1, 2011. These are in addition to the two CPT® codes 99406 and 99407 that currently are used for tobacco cessation counseling for symptomatic individuals. Medicare will waive the deductible and coinsurance/copayment for counseling and billing with these two new G codes on or after January 1, 2011."

"CMS will allow two individual tobacco cessation counseling attempts per year. Each attempt may include a maximum of four intermediate (more than 3 minutes up to 10 minutes) OR intensive sessions (more than 10 minutes), with a total benefit covering up to 8 sessions per year per Medicare beneficiary who uses tobacco." "This policy is consistent for all service codes (G-codes and standard CPT® codes)," says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania Department of Medicine in Philadelphia.

3-minute cut off: You should include counseling that lasts up to three minutes in reimbursement for the standard evaluation and management (E/M) office visit (99201-99215, Office or other outpatient visit for the evaluation and management of a new patient...). If the counseling exceeds three minutes, you should report G0436 or G0437.

ICD-9 connection: Make sure you link the G code to ICD-9 305.1 (Nondependent abuse of drugs; tobacco use disorder) or V15.82 (Personal history of tobacco use) for those patients who are asymptomatic for tobacco related diseases.

Reminder: Forego the G codes and "use codes 99406 and 99407 when the patient has a condition, such as COPD [490-496] or asthma [493] that is exacerbated by tobacco use (or history of tobacco use). CPT® describes these codes as behavior change intervention -- performed as part of the treatment for a condition (e.g., COPD) related to or potentially exacerbated by the behavior," says Pam Brooks, PCS, CPC, physician services coding supervisor, Wentworth-Douglass Hospital in Dover, NH.

When reporting any significant and separately identifiable E/M service on the same date as tobacco-use cessation counseling, append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code.