Pulmonology Coding Alert

Question: Will insurers pay for smoking-cessation treatments? If so, what codes and documentation should we use?

New York Subscriber Answer: Typically, when a health professional other than a physician provides smoking-cessation treatments, you could report G9016 (Smoking-cessation counseling, individual, in the absence of or in addition to any other evaluation and management service, per session [6-10 minutes] [demo project code only]). If the physician counsels the patient regarding smoking, you should include this service with the E/M code.

Remember that Medicare will not pay for G9016, because the government lists it as a "demo project code." And, many private payers may not pay for this service, so check with your individual carrier before filing the claim.

You may be able to report smoking cessation as health and behavior intervention (96152-96153, Health and behavior intervention, each 15 minutes, face-to-face ...) for patients with smoking-related health problems, such as emphysema (492.x).

Also, the physician must be able to attribute the smoking to biopsychosocial factors (for example, smoking in response to stress), according to CPT guidelines. These intervention programs assist the patient in behavior modification as a way to quit smoking.

Medicare will pay for these codes. But you should report them only when a nonphysician professional provides 15 minutes of face-to-face intervention.