Pulmonology Coding Alert

Question: A smoker for 20 years, with breathing problems, came to the provider. The provider performed an E/M service, followed by which the NPP administered smoking cessation counseling to the patient for 30 minutes, and asked him for a follow up every three months. How do I code for this scenario? Do CMS guidelines cover this scenario?

Colorado Subscriber

Answer: CMS covers smoking and tobacco use cessation counseling for outpatient and hospitalized Medicare beneficiaries who use tobacco, regardless of whether they have signs or symptoms of tobacco-related disease.

When a NPP performs the service, you may report codes 99406 (Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes) and 99407 (Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes) for smoking cessation counseling for the NPP in conjunction with the physician’s service under Medicare Part B. Only the physician or other qualified healthcare professional recognized by Medicare can bill Medicare directly for the service.

If your provider provides minimal counseling, say three minutes or less, along with the evaluation and management (E/M) visit, it’s covered within the E/M service. In this case, as the NPP furnishes the smoking cessation counseling services on the same day as a scheduled office visit, you may append modifier 25 to the E/M code to indicate that the E/M service is a separately identifiable service from smoking cessation counseling, e.g., 99213-25 under the physician plus 99406 under the NPP.

“The guidelines only state that it must be billed by a Medicare-recognized billing provider. The “incident-to” language was removed as it applied to FQRHFs” says Carol Pohlig, BSN, RN, CPC, ACS,  senior coding and education specialist at the Hospital of the University of Pennsylvania.

As for the number of sessions your provider can bill for, Medicare covers two individual smoking cessation counseling attempts per year. Each attempt may include a maximum of 4 intermediate OR intensive sessions, with the total benefit covering up to 8 sessions in a 12-month period.