Pulmonology Coding Alert

Question: Which Medicare patients qualify for tobacco cessation counseling?

Codify Subscriber

Answer: Medicare maintains very specific guidelines for 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), according to the agency’s Fact Sheet on Counseling to Prevent Tobacco Use.

According to the CMS policy, you can collect for tobacco cessation counseling for outpatient and hospitalized Medicare beneficiaries as long as the following criteria are met:

• The patient uses tobacco, regardless of whether they exhibit signs or symptoms of tobacco-related disease
• The patient is competent and alert at the time of counseling
• The counseling is furnished by a qualified physician or other Medicare-recognized practitioner

Bonus: Medicare waives the copayment/coinsurance as well as the deductibles when you report 99406 or 99407.

Resource: To read Medicare’s Fact Sheet on Preventive Services, visit https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-preventive-services/MPS-QuickReferenceChart-1.html#LUNG_CAN.